Antibiotic resistance pattern among aerobic bacterial isolates from osteomyelitis cases attending a Tertiary care hospital of North India with special reference to ESBL, AmpC, MBL and MRSA production

Abstract

Background: Osteomyelitis is a common cause of morbidity in developing countries. Its treatment comprises of surgical debridement of all necrotic bone and soft tissue along with use of appropriate antimicrobial therapy. Treatment is becoming increasingly troublesome due to rise in drug resistant isolates in osteomyelitis cases. The present study was done to determine the antibiotic resistance pattern among aerobic bacterial isolates from osteomyelitis cases.Methods: 125 samples from osteomyelitis cases were aerobically cultured and isolates from culture positives were identified by standard procedures. Antimicrobial susceptibility testing was done by Kirby Bauer disk diffusion method. Staphylococcal isolates were screened for methicillin resistance and Gram negative bacilli were screened and confirmed for ESBL, AmpC and MBL production.Results: Out of 125 samples cultured, 20 were culture negative and 105 were culture positive giving rise to 120 isolates (58 Gram positive and 62 Gram negative organisms). The prevalence of methicillin resistant staphylococcal (MRS) isolates, ESBL, AmpC and MBL producers was found to be 43.1%, 51.6%, 24.2% and 14.5% respectively. All the resistant isolates were multidrug resistant, with MRS being 100% sensitive only to vancomycin, linezolid and teicoplanin, ESBL and AmpC producers being 100% sensitive only to imipenem and colistin, and MBL producers being 100% sensitive only to colistin.Conclusions: Antibiotic therapy on the basis of antibiotic susceptibility pattern helps the clinician to choose appropriate drugs leading to successful treatment and prevention of emergence and dissemination of drug resistant isolates.

Clinical and microbiological profile of post-traumatic osteomyelitis in tertiary hospital in Yaoundé –Cameroon

“…This high predominance of the male gender and the youthful age group could be attributable to the greater likelihood of trauma and compound fractures in this population group in relation with their daily activities. These results are similar to those obtained in a study done in India in 2017 also reported a higher cases of osteomyelitis among younger age groups of 31-40 (32.8%) followed by 21-30 (25.6%) [4] . A study in Brazil, 2012 reported similar results [5] .…”

“…The difference could be explained by the fact that they mostly had community acquired germs. The studies carried in India in 2013 [11] and 2017 [4] had comparable results with ours. They showed reduced sensitivity (less than 50%) to quinolones, aminoglycosides, Cotrimoxazole and to Cephalosporins.…”

“…This corresponds to the profile of nosocomial germs showing the latter a major role in posttraumatic osteomyelitis in our context. This does not correlate with most studies as Staphylococcus aureus is often reported to be the first causative agent [4,11,14,15] . A similar study done in Iraq in 1998 however reported Pseudomas sp, Klebsiella sp and Proteus sp to be more predominant than Staphylococcus aureus [16] .…”

“…The most affected bones were the same as for our study and included the tibia (58%) and the femur (31%). Another study realized in India in 2016 [4] identified as predisposing factors open fractures (45.6%), post-operative infections (27.2%) and implants (24.0%). The most affected bones also included tibia and the femur (44.0% and 40.8%) respectively.…”

A study of prevalence of staphylococcus aureus and its antibiotic susceptibility pattern in 100 osteomyelitis patients in a tertiary care teaching hospital

“…In the current study, the most common predisposing factor leading to osteomyelitis was trauma due to road side accidents accounting for 45% cases followed by post-operative infections (21%), orthopaedic implants (17%), haematogenous (11%), diabetes mellitus (4%) and others. This is in concordance with a study by Wadekar MD et al [11] who concluded trauma (44%) as the commonest predisposing factor followed by post-operative infections (23%) and orthopaedic implants (23%) and also similar to the findings of Khatoon R et al [12] according to whom the most common predisposing factor was trauma leading to open fractures (45.6%) In the present study, it was found that tibia was the commonest bone affected by the osteomyelitis (36%), followed by femur (32%). However, our study differs from study of Wadekar MD et al [11] which showed highest incidence of osteomyelitis in femur (48%) followed by tibia (23%).…”