Lack of microbiological concordance between bone and non-bone specimens in chronic osteomyelitis: an observational study (original) (raw)
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Etiologic Diagnosis of Chronic Osteomyelitis
Archives of Internal Medicine, 2006
Background: Although bone specimens were established 25 years ago as the gold standard for etiologic diagnosis of chronic osteomyelitis, recent studies suggest that nonbone specimens are as accurate as bone to identify the causative agent. We examined concordance rates between cultures from nonbone and bone specimens in 100 patients.
Journal of Infection and Public Health, 2020
Background: The diagnosis of osteomyelitis is invasive and expensive as the current standard technique is the bone biopsy. Our aim was to compare the degree of agreement and concordance between standard bone biopsy and other non-bone techniques. Methods: We performed an electronic search through 12 electronic databases to retrieve relevant studeis. Our criteria included any original article that reported the degree of agreement and/or the concordance between bone biopsy and other non-bone techniques in diagnosing osteomyelitis. We published our protocol in PROSPERO with a registration number, CRD42017080336. Results: There were 29 studies included in the qualitative analysis, of which 15 studies were included in the meta-analysis. Samples from sinus tract had the highest concordance with bone biopsy samples, while swab samples were the least concordant with bone biopsy samples. Additionally, Abbreviations: COM, chronic osteomyelitis; S. aureus, Staphylococcus aureus; SR/MA, systematic review/meta-analysis; PRISMA, preferred reporting items for systematic review and meta-analysis checklist; ISI, web of science; VHL, virtual health library; GHL, WHO global health library; mRCT, controlled trials; SIGLE, system for information on grey literature in Europe.
Journal of Infection, 2010
This study describes the microbiological spectrum of chronic osteomyelitis and so guides the choice of empirical antibiotics for this condition. Methods: We performed a prospective review of a 166 prospective patient series of chronic osteomyelitis from Oxford, UK in which a standardised surgical sampling protocol was used. Results: Staphylococcus aureus was most commonly isolated (32%) amongst a wide range of organisms including gram negative bacilli, anaerobes and coagulase negative staphylococci. Low grade pathogens were not confined to patients with a history of metalwork, a high proportion of cases were polymicrobial (29%) and culture negative cases were common (28%). No clear predictors of causative organism could be established. Many isolates were found to be resistant to commonly used empirical anti-microbial regimens. Conclusions: The wide range of causative organisms and degree of resistance to commonly used anti-microbials supports the importance of extensive intra-operative sampling and provides important information to guide clinicians' choice of empirical antibiotics.
IP innovative publication pvt. ltd, 2019
Introduction: Chronic osteomyelitis is a important medical illness among developing countries, it is a very expensive disease for the patient and society mostly associated with trauma and surgery as risk factors. There is a constant change in the trend of organisms involved and resistance pattern seen with advent of newer antibiotics, So early and specific therapy is needed. With this background present study aims to look for the varying trends of microorganisms involved in osteomyelitis and their antimicrobial susceptibility pattern. Materials and Methods: A total of 100 cases studied over a period of one year, samples processed by following standard laboratory protocols and along with routine antimicrobial testing screening for MRSA done. Results: Among 100 cases, 76 were males and 24 were females, between age group of 11 –60 years. Long bones are most involved with trauma (45%) as risk factor. Staphylococcus aureus (51%) predominant pathogen isolated with 27(53%) were MRSA, followed by Pseudomonas aeruginosa (16%). Antibiotic sensitivity testing of gram positive organisms showed hundred percent sensitivity to Linezolid and Vancomycin with poor sensitivity to Pencillin (10/15.6%). Among gram negative organisms, majority showed highest sensitivity to Amikacin (73.3%) & Imipenem (71.1%) with poor sensitivity to Ciprofloxacin (20.0%) and Ampicillin (0%). Conclusion: Chronic osteomyelitis is a prime challenging problem in many countries with severe morbidity. Mostly due to neglect, delayed or inadequate treatment and emerging drug resistant pathogens involved. Culture based antibiotic therapy helps in effectively treating the disease also prevents the drug resistance.
Gram-negative osteomyelitis: clinical and microbiological profile
The Brazilian Journal of Infectious Diseases, 2012
Despite the growing interest in the study of Gram-negative bacilli (GNB) infections, very little information on osteomyelitis caused by GNB is available in the medical literature. Objectives and methods: To assess clinical and microbiological features of 101 cases of osteomyelitis caused by GNB alone, between January 2007 and January 2009, in a reference center for the treatment of high complexity traumas in the city of São Paulo. Results: Most patients were men (63%), with median age of 42 years, affected by chronic osteomyelitis (43%) or acute osteomyelitis associated to open fractures (32%), the majority on the lower limbs (71%). The patients were treated with antibiotics as inpatients for 40 days (median) and for 99 days (median) in outpatient settings. After 6 months follow-up, the clinical remission rate was around 60%, relapse 19%, amputation 7%, and death 5%. Nine percent of cases were lost to follow-up. A total of 121 GNB was isolated from 101 clinical samples. The most frequently isolated pathogens were Enterobacter sp. (25%), Acinetobacter baumannii (21%) e Pseudomonas aeruginosa (20%). Susceptibility to carbapenems was about 100% for Enterobacter sp., 75% for Pseudomonas aeruginosa and 60% for Acinetobacter baumannii. Conclusion: Osteomyelitis caused by GNB remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.
Osteomyelitis: Etiology, Diagnosis, Treatment and Outcome in a Public versus a Private Institution
Infection, 2001
Although bone infections are difficult to diagnose and manage, primary health care providers often give comprehensive care to patients with few referrals. To evaluate how trends in care impact upon management of bone infections, we performed a retrospective review of medical records of 198 osteomyelitis patients. Patients and Methods: 130 patients were hospitalized at a private institution and 68 were hospitalized at a public (teaching) institution. Outcomes measured were bone salvage or loss in relation to predisposing co-morbidities and infectious disease (ID) physician involvement in the patient care. Results: Co-morbidities predominating at the public and private hospitals, respectively, were presence of metal implants (20% and 37%) and diabetes (32% and 31%). The most common pathogens at the public and private hospitals, respectively, were methicillin-susceptible Staphylococcus aureus (MSSA, 16 and 32%) and methicillin-resistant S. aureus (MRSA, 3% and 31%). ID specialists treated longer with iv antibiotics (42 and 43.5 median treatment days) than non-ID specialists (14 and 7 median treatment days). When ID specialists were involved in case management, a trend to bone salvage was seen at the public hospital (p < 0.09). Conclusion: Osteomyelitis patient outcome varies less by hospital setting than by case management.
Bacterial Aetiology of Bone Lesions, in a Tertiary Care Hospital
Biomedica, 2009
This study was planned to observe the bacteriological pattern of causative organisms of osteomyelitis reporting to orthopedic unit at Ghurki Trust Teaching Hospitals, (GTTH) Lahore. The objective of this study was to know the type / frequency of infection in orthopaedic surgery in a public hospital and its treatment. It is a retrospective study carried out between Dec 2006 and Jan 2008. A total of one hundred and sixty five (165) patient samples were received at Lahore Medical and Dental College Lahore (LM&DC) during this period. They included 113 males and 52 females with age range of 01 to 80 years. All the patients were investigated in outpatient departments and Orthopaedic wards. Among the 165 patient investigated only 89 were found infected (63 males and 26 females). The commonest infecting organism isolated was Staphylococcus (54%) followed by enterobacteriaceae (23%) that included (proteus spp (12.5%), E.coli (8%), Klebseilla (2.5%) Pseudomonas aeruginosa (18%), anaerobes (2.5%) and miscellaneous (2.5%). Two (2.5%) anerobic bacteria were isolated, anaerobic bacteria were peptostreptococci and bacteroides either alone or as a mixed infection. The different kind of bacterial isolation shows no relation with age and gender. This increase in Pseudomonas aeruginosa as a significant bone pathogen is related to the increasing nosocomial nature of osteomyelitis.