Post-traumatic osteomyelitis in Middle East war-wounded civilians: resistance to first-line antibiotics in selected bacteria over the decade 2006–2016

Abstract

BackgroundWar-wounded civilians in Middle East countries are at risk of post-traumatic osteomyelitis (PTO). We aimed to describe and compare the bacterial etiology and proportion of first-line antibiotics resistant bacteria (FLAR) among PTO cases in civilians from Syria, Iraq and Yemen admitted to the reconstructive surgical program of Médecins Sans Frontières (MSF) in Amman, Jordan, and to identify risk factors for developing PTO with FLAR bacteria.MethodsWe retrospectively analyzed the laboratory database of the MSF program. Inclusion criteria were: patients from Iraq, Yemen or Syria, admitted to the Amman MSF program between October 2006 and December 2016, with at least one bone biopsy sample culture result. Only bone samples taken during first orthopedic surgery were included in the analysis. To assess factors associated with FLAR infection, logistic regression was used to estimate odds ratio (ORs) and 95% confidence intervals (CI).Results558 (76.7%) among 727 patients included had ≥1 positive culture results. 318 were from Iraq, 140 from Syria and 100 from Yemen. Median time since injury was 19 months [IQR 8–40]. Among the 732 different bacterial isolates, we identified 228 Enterobacteriaceae (31.5%), 193 Staphylococcus aureus (26.3%), 99 Pseudomonas aeruginosa (13.5%), and 21 Acinetobacter baumanii (2.8%). Three hundred and sixty four isolates were FLAR: 86.2% of Enterobacteriaceae, 53.4% of Pseudomonas aeruginosa, 60.5% of S. aureus and 45% of Acinetobacter baumannii. There was no difference in bacterial etiology or proportion of FLAR according to the country of origin. In multivariate analysis, a FLAR infection was associated with an infection of the lower extremity, with a time since the injury ≤12 months compared with time > 30 months and with more than 3 previous surgeries.ConclusionsEnterobacteriaceae were frequently involved in PTO in war wounded civilians from Iraq, Yemen and Syria between 2006 and 2016. Proportion of FLAR was high, particularly among Enterobacteriaceae, regardless of country of origin.Electronic supplementary materialThe online version of this article (10.1186/s12879-019-3741-9) contains supplementary material, which is available to authorized users.

Extracellular Vesicles: A Potential Biomarker for Quick Identification of Infectious Osteomyelitis

“…Posttraumatic or postoperative osteomyelitis, a common and serious complication in orthopedic trauma, presents a variety of clinical challenges. Clinical data have demonstrated that Staphylococcus aureus is a leading pathogen for osteomyelitis, followed by Staphylococcus epidermidis, Pseudomonas aeruginosa , and Escherichia coli (Jiang et al, 2015 ; Ma et al, 2018 ; Fily et al, 2019 ). Prompt diagnosis, timely identification of causative pathogenic bacteria, and appropriate antibiotics are critical for an effective treatment of osteomyelitis.…”

Treatment of sepsis secondary to blast injuries

“…They should be considered as polytrauma patients because of having not only extremity injuries but also other systemic organ injuries. Infections after contamination on the battlefield or in the hospital can cause sepsis and death (12,13). War injuries should be considered as systemic injuries rather than isolated injuries and their treatment should be performed multidisciplinarily, not by a single clinic (8).…”

KR‑12‑a6 promotes the osteogenic differentiation of human bone marrow mesenchymal stem cells via BMP/SMAD signaling

“…Bone infection and osteolysis are common clinical symptoms of osteomyelitis, which requires local or systemic treatment with antibiotics (32). With the rise of drug-resistant bacteria in clinical bone infection, traditional antibiotics have become less effective (18–20). Due to their low drug resistance and excellent antimicrobial properties, AMPs have received increasing attention.…”

“…Osteomyelitis is a common infectious disease that can cause serious symptoms locally or systemically, such as severe pain, high fever, swelling and tenderness around the infection site, posing a great challenge to clinical treatment (16). In addition to the surgical removal of infected bone tissues, local or systemic application of antibiotics is the most common treatment (17); however, with the increasing use of antibiotics to treat bone infections in the clinic, bacterial resistance to antibiotics has gradually developed (18). In addition, osteolysis caused by infection cannot be treated with traditional antibiotics.…”