The microbiology of chronic osteomyelitis: Changes over ten years

Dudareva, Maria; Hotchen, Andrew J.; Ferguson, Jamie; Hodgson, Susanne H.; Scarborough, Matthew; Atkins, Bridget L.; McNally, Martin

doi:10.1016/j.jinf.2019.07.006

Cited by 66 publications

(59 citation statements)

References 24 publications

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“…Reported cases of MDR nonfermenters in the orthopaedic literature are too low to be comparable; however, we note that our rates of MDR S. aureus are consistent with other studies [20,21,[23][24][25][26]. In their assessment of pathogens cultured from surgical site infections following joint arthroplasty and spinal fusions, Norton et al found that 33% of S. aureus was methicillin-resistant and similarly, Dudareva et al identified that 22.5% of S. aureus species cultured from chronic osteomyelitis patients in the United Kingdom were MDR [20,24]. MDR S. aureus and nonfermenters may be more endemic in the Australian tropical healthcare system for a variety of reasons.…”

Section: Discussionsupporting

confidence: 91%

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Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

Vickers

Ballard

Harris

et al. 2020

IJERPH

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We aimed to describe the epidemiology, multi-drug resistance and seasonal distribution of bacteria cultured within 12 months following lower limb orthopaedic surgery in tropical and subtropical Australian hospitals between 2010 and 2017. We collected data from four tropical and two subtropical hospitals. Categorical variables were examined using the Pearson Chi-squared test or Fisher’s Exact test, and continuous variables with the Student t-test or Mann–Whitney U test. A Poisson regression model was used to examine the relationship between season, weather and the incidence of Staphylococcus and nonfermentative species. We found that at tropical sites, nonfermenters (Pseudomonas aeruginosa and Acinetobacter baumannii) were more common (28.7% vs. 21.6%, p = 0.018), and patients were more likely to culture multi-drug-resistant (MDR) nonfermenters (11.4% vs. 1.3%, p = 0.009) and MDR Staphylococcus aureus (35.9% vs. 24.6%, p = 0.006). At tropical sites, patients were more likely to be younger (65.9 years vs. 72.0, p = < 0.001), male (57.7% vs. 47.8%, p = 0.005), having knee surgery (45.3% vs. 34.5%, p = 0.002) and undergoing primary procedures (85.0% vs. 73.0%, p = < 0.001). Species were similar between seasons in both tropical and subtropical hospitals. Overall, we found that following lower limb orthopaedic surgery in tropical compared with subtropical Australia, patients were more likely to culture nonfermenters and some MDR species.

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Section: Discussionsupporting

confidence: 91%

“…The frequency of P. aeruginosa and A. baumannii identified in our study was higher than elsewhere in the literature. In their cohort of orthopaedic trauma patients in Brazil, Tuon [20][21][22]. In Taiwan, Wang et al also identified lower rates of P. aeruginosa, which made up just 2.8% of pathogens causing prosthetic joint infection [23].…”

Section: Discussionmentioning

confidence: 99%

Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

Vickers

Ballard

Harris

et al. 2020

IJERPH

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“…Bone infection at poorly vascularized sites is often difficult to treat and requires a prolonged and intensive antimicrobial therapy along with surgical drainage or debridement. In the majority of bone and joint infections, gram-positive organisms, particularly, Staphylococcus aureus , are the main causative microbes [9,10]. Staphylococcus aureus is the major infecting microbe accounting for approximately 50% cases of human osteomyelitis because of its capacity to express bacterial adhesion molecules, that aid in attachment to extracellular bone matrix.…”

Section: Epidemiologymentioning

confidence: 99%

From Crosstalk between Immune and Bone Cells to Bone Erosion in Infection

Kumar

Roger

2019

IJMS

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Bone infection and inflammation leads to the infiltration of immune cells at the site of infection, where they modulate the differentiation and function of osteoclasts and osteoblasts by the secretion of various cytokines and signal mediators. In recent years, there has been a tremendous effort to understand the cells involved in these interactions and the complex pathways of signal transduction and their ultimate effect on bone metabolism. These crosstalk mechanisms between the bone and immune system finally emerged, forming a new field of research called osteoimmunology. Diseases falling into the category of osteoimmunology, such as osteoporosis, periodontitis, and bone infections are considered to have a significant implication in mortality and morbidity of patients, along with affecting their quality of life. There is a much-needed research focus in this new field, as the reported data on the immunomodulation of immune cells and their signaling pathways seems to have promising therapeutic benefits for patients.

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“…Chronic osteomyelitis can induce bone defects, osteonecrosis, and lead to a high recurrence of secondary infection. 5,6 Therefore, treating chronic osteomyelitis is often challenging as both the infection and subsequent bone repair must be addressed.…”

Section: Introductionmentioning

confidence: 99%

<p>Injectable Chitosan-Based Thermosensitive Hydrogel/Nanoparticle-Loaded System for Local Delivery of Vancomycin in the Treatment of Osteomyelitis</p>

Jin¹,

Zhang²,

Shen³

et al. 2020

IJN

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Purpose: Osteomyelitis, particularly chronic osteomyelitis, remains a major challenge for orthopedic surgeons. The traditional treatment for osteomyelitis, which involves antibiotics and debridement, does not provide a complete solution for infection and bone repair. Antibiotics such as vancomycin (VCM) are commonly used to treat osteomyelitis in clinical settings. VCM use is limited by a lack of effective delivery methods that provide sustained, high doses to entirely fill irregular bone tissue to treat infections. Methods: We engineered a chitosan (CS)-based thermosensitive hydrogel to produce a VCM-nanoparticle (NPs)/Gel local drug delivery system. The VCM-NPs were formed with quaternary ammonium chitosan and carboxylated chitosan nanoparticles (VCM-NPs) by positive and negative charge adsorption to enhance the encapsulation efficiency and drug loading of VCM, with the aim of simultaneously preventing infection and repairing broken bones. This hydrogel was evaluated in a rabbit osteomyelitis model. Results: The VCM-NPs had high encapsulation efficiency and drug loading, with values of 60.1±2.1% and 24.1±0.84%, respectively. When embedded in CS-Gel, the VCM-NPs maintained their particle size and morphology, and the injectability and thermosensitivity of the hydrogel, which were evaluated by injectability test and rheological measurement, were retained. The VCM-NPs/Gel exhibited sustained release of VCM over 26 days. In vitro tests revealed that the VCM-NPs/Gel promoted osteoblast proliferation and activity against Staphylococcus aureus. In vivo, VCM-NPs/Gel (with 10 mg vancomycin per rabbit) was used to treat rabbits with osteomyelitis. The VCM-NPs/Gel showed excellent anti-infection properties and accelerating bone repair under osteomyelitis conditions. Conclusion: The reported multifunctional NPs hydrogel system for local antibiotic delivery (VCM-NPs/Gel) showed bone regeneration promotion and anti-infection properties, demonstrating significant potential as a scaffold for effective treatment of osteomyelitis.

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The microbiology of chronic osteomyelitis: Changes over ten years

Cited by 66 publications

References 24 publications

Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

Bacterial Profile, Multi-Drug Resistance and Seasonality Following Lower Limb Orthopaedic Surgery in Tropical and Subtropical Australian Hospitals: An Epidemiological Cohort Study

From Crosstalk between Immune and Bone Cells to Bone Erosion in Infection

<p>Injectable Chitosan-Based Thermosensitive Hydrogel/Nanoparticle-Loaded System for Local Delivery of Vancomycin in the Treatment of Osteomyelitis</p>

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