Background/Objectives: Osteoarticular infections are common complications of sickle cell disease (SCD), often posing significant challenges in diagnosis and management. They primarily affect children: however, the recurrence or emergence of these infections in adults as new complications is well documented. Despite this, there is a notable lack of literature focused on diagnosis and management strategies for adult SCD patients. Our research aims to explore the management challenges in adult SCD patients and to evaluate the outcomes of a selected conservative management approach. Methods: The authors conducted a single-center retrospective observational study from January 2018 to December 2022. All adult SCD patients admitted with suspected or confirmed osteoarticular infections were included. Relevant data were meticulously extracted from patients’ hard and electronic medical files. Descriptive statistics were used to present the frequencies and percentages, and suitable statistical analyses were employed to identify specific clinical features and management outcomes in adult patients with SCD. Results: Thirty-one patients with osteoarticular infections were included; the majority were males (87.1%) with a mean age of 26.55 years. Long bones were frequently affected, with femurs being the most infected sites (28.1%). Infection recurred in 41.9% of patients. Most patients were managed conservatively (93.5%), primarily with clindamycin and ciprofloxacin, for approximately six weeks, resulting in an excellent cure rate of 96.8%. Conclusions: The current study highlights the specific clinical features of osteoarticular infections in adult patients with SCD, identifies radiological findings on Magnetic Resonance Imaging, and suggests a conservative, non-invasive approach for management with excellent outcomes.

Background: Stenotrophomonas maltophilia is an intrinsically multidrug-resistant, biofilm- forming, non-fermenter increasingly implicated in hospital-acquired infections. Evidence from non-cystic fibrosis populations, especially in the Middle East, remains sparse. Methods: We conducted a retrospective observational cohort study at a tertiary academic center (Al-Khobar, Saudi Arabia) spanning 1 May 2001–30 April 2023. Hospitalized adults (≥18 years) with culture-confirmed, clinically diagnosed S. maltophilia infection and ≥72 h of antibiotic therapy were included. The primary outcome was all-cause mortality (14-day, 30-day, 1-year). Secondary outcomes were clinical response, microbiological eradication, and infection recurrence. Predictors of 30-day mortality were assessed using multivariable logistic regression; 14-day mortality was analyzed by Kaplan–Meier/log-rank according to susceptibility-guided versus alternative therapy. Results: Of 539 patients with positive cultures, 436 met the inclusion criteria. Mean age was 60.5 ± 19.3 years; 62.2% were male. Most infections were hospital-acquired (92.9%); pneumonia composed 64.7% and bloodstream infection 15.4%. Polymicrobial growth occurred in 55.5% (predominantly Gram-negative co-isolation). Susceptibility was 95.1% to trimethoprim–sulfamethoxazole, 76.4% to levofloxacin, and 43.6% to ceftazidime. Mortality at 14 days, 30 days, and 1 year was 22.8%, 37.9%, and 57.2%, respectively. On multivariable modelling, intensive care unit (ICU) admission, leukocytosis, neutrophilia, anemia, and thrombocytopenia independently predicted 30-day mortality. Susceptibility-guided therapy was associated with improved 14-day survival (log-rank p = 0.033). Conclusions: In this large, long-running non-cystic fibrosis cohort, host acuity and early alignment of treatment to susceptibility data were dominant drivers of outcome. High polymicrobial burden and limited reliably active agents underscore the need for meticulous stewardship, robust infection prevention, and cautious interpretation of S. maltophilia antimicrobial susceptibility testing.