The microbiology of chronic osteomyelitis: Prevalence of resistance to common empirical anti-microbial regimens

Sheehy, Shanshan; Atkins, Bridget; Bejon, Philip; Byren, Ivor; Wyllie, David; Athanasou, Nicholas A.; Berendt, Anthony R.; McNally, Martin

doi:10.1016/j.jinf.2010.03.006

Cited by 122 publications

(129 citation statements)

References 19 publications

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“…In this series, the prevalence of polymicrobial infections was somewhat higher (45%) than previously reported in studies performed in the developed world setting. 2,3 Trampuz et al found polymicrobial infections in 27% of patients. 2 Sheehy et al reported that 29% of their cases were polymicrobial in nature.…”

Section: Discussionmentioning

confidence: 99%

“…2 Sheehy et al reported that 29% of their cases were polymicrobial in nature. 3 Spellberg and Lipsky reviewed publications, from 1970 to 2011, related to the use of antibiotics in chronic osteomyelitis. 11 The authors emphasised the importance of surgical debridement and noted that the cure rate of chronic osteomyelitis is increased with surgical resec tion of infected and devitalised tissue in conjunction with antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…1 In recent times this category has been supplemented considerably by contiguous infections which are caused by a much wider range of microorganisms. 2,3 Posttraumatic, post-operative and implant-related infections are now encountered much more frequently, especially in developed regions. 2,3 Overall, infectious complications can be expected in approximately 1-5% of internally fixated closed fractures and in up to 30% of open fractures.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Posttraumatic, post-operative and implant-related infections are now encountered much more frequently, especially in developed regions. 2,3 Overall, infectious complications can be expected in approximately 1-5% of internally fixated closed fractures and in up to 30% of open fractures. 4 Irrespective of the cause, chronic osteomyelitis remains difficult to treat and treatment failure may occur in more than 10% of cases.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown that the most common causative organism remains Staphylococcus aureus, followed by Enterobacteriaceae. [1][2][3] Few studies have been performed in the developing world. Furthermore, the variation of causative organism in relation to the physiological host status, the HIV status of the patient or the cause of the infection has not previously been reported.…”

Section: Introductionmentioning

confidence: 99%

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The microbiology of chronic osteomyelitis in a developing world setting

Mthethwa

Marais

2017

SA orthop. j.

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Objectives: The primary aim of this study was to identify the microorganisms that cause chronic osteomyelitis in a developing world clinical setting and to characterise the antibiotic sensitivity profile of these pathogens. Furthermore, we aimed to determine whether the causative organisms vary in relation to physiological status of the host, the HIV status of the patient or the cause of the infection (post-traumatic, post-operative and haematogenous). Methods:We performed a retrospective review of consecutive adult patients treated curatively for chronic osteomyelitis of long bones, over a two-year period. Patient charts were reviewed and data extracted in respect of patient demographics, the cause of infection, physiological status of the host in accordance with the Cierny and Mader classification, HIV status, surgical treatment strategy and causative organism.Results: A total of 108 organisms were identified in the 60 patients included in the study. Multiple organism were cultures in 45% of patients, a single Gram-positive organism in 22% and a single Gram-negative organism in 26% of patients. In four cases (7%) no causative organism was cultured. The most prevalent organisms were Enterobacteriaceae (34%), Staphylococcus spp. (29%), Pseudomonas aeruginosa (11%), and Enterococcus spp. (9%). Many isolates were found to be resistant to commonly used empirical anti-microbial agents. Seventy per cent of Enterobacteriaceae spp. were resistant to either cefuroxime and/or ampicillin-clavulanic acid. Seventy-seven per cent of Staphylococcus aureus isolates were susceptible to cloxacillin. More than 50% of Pseudomonas aeruginosa strains were resistant to meropenem, imipenem, piperacillin-tazobactam or cefepime. There was a significant association between the aetiology of the infection and the microorganisms involved (p-value < 0.01). The bacterial pathogen profile was, however, not associated with the physiological status of the host (p=0.22) or the HIV status of the patient. Conclusion:While the majority of haematogenous chronic osteomyelitis still involved a solitary Gram-positive organism, the incidence of Gram-negative infections was found to be higher than previously reported. Contiguous chronic osteomyelitis was mostly polymicrobial in nature and solitary infections involving a Gramnegative organism was most common in the post-traumatic group. The bacterial pathogen did not vary in relation to the HIV status of the patient or the physiological status of the host.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The microbiology of chronic osteomyelitis in a developing world setting

Mthethwa

Marais

2017

SA orthop. j.

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Antibiotics for treating chronic osteomyelitis in adults

Conterno

Turchi

2013

Cochrane Database of Systematic Reviews

179

174

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Limited and low quality evidence suggests that the route of antibiotic administration (oral versus parenteral) does not affect the rate of disease remission if the bacteria are susceptible to the antibiotic used. However, this and the lack of statistically significant differences in adverse effects need confirmation. No or insufficient evidence exists for other aspects of antibiotic therapy for chronic osteomyelitis.The majority of the included trials were conducted over 20 years ago and currently we are faced with a far higher prevalence of bacteria that are resistant to many of the available antibiotics used for healthcare. This continuously evolving bacterial resistance represents another challenge in the choice of antibiotics for treating chronic osteomyelitis.

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