Aerobic Microbiological Profile Of Contigious Focus Osteomyelitis
Aerobic Microbiological Profile Of Contigious Focus Osteomyelitis
Keywords:
Osteomyelitis, Contigious Focus OsteomyelitisAbstract
Background: Bone and Joint infections are painful for patients and frustrating for them and their doctors. Eradication of infection from bone is difficult since there is fibrosis and low vascularity due to chronic inflammation where antibiotics are difficult to reach. Such infections tend to persist until the infected biomaterial and the adjacent tissues are removed. Osteomyelitis is also a disease in transition with ongoing changes in predisposing factors, causative organism and treatment. The relative frequency of haemetogenous osteomyelitis and relapsing osteomyelitis continues to decline, conversely the incidence of bone infections related to joint replacements, complex surgical interventions and wound infections are increasing. Factors involved in choosing the appropriate antibiotics include infection type, infecting organism, sensitivity results and antibiotic characteristics. Objective: To know microbiological etiology in different types of osteomyelitis in our region. Material & Methods: Specimens were collected from clinically and radiologically diagnosed 97 patients of Contiguous focus osteomyelitis, In cases of contiguous focus osteomyelitis presenting with sinus tract, deeper material from sinus tract was collected, wherein surgical intervention was required operative biopsy from bone or scrapping from prostheis was collected. Tissue biopsy/ sequestrum obtained were homogenized with sterile mortar and pestle with little sterile broth, for microscopic examination and inoculation. Pus, aspirate, sinus swab were directly used for microscopic examination and Inoculation. All the samples were inoculated on sheep blood agar and MacConkey agar. The plates were examined for growth after 24 hrs. Any growth was identified by colony characters & standard biochemical tests. Results: Staphylococcus aureus was etiological agent (42.05%) in majority of contiguous focus osteomyelitis. Enterobacteriaceae organisms and Pseudomonas aeruginosa were also found to be common agents (11.36% each).Poly-microbial etiology was evident in 15 (17.04%) cases In all 9 cases of contiguous focus osteomyelitis secondary to vascular insufficiency poly-microbial flora was seen. Conclusion: Bone infections that originate from contiguous soft tissue infections can have various etiologies and may even be due to mixture of bacteria from multiple genera Staphylococcus aureus is most common etiology [ Hassani U NJIRM 2014; 5(3) :102-107]
References
2. Mader JT, Shirtliff ME, Calhoun JH. The host and the skeletal infection: Classification and pathogenesis of acute bacterial bone and joint sepsis. Bailleres Best Pract Res Clin Rheumatol 1999 a; 13: 1 – 20.
3. Hass DW, McAndrew MP, Bacterial osteomyelitis in adults: evolving considerations in diagnosis and treatment. Am. J. Med 1996; 101: 550 –61.
4. Lew DP, Waldvogel FA. Osteomyelitis. NEJM 1997; 336 : 999 – 1007.
5. Mader JT, Shirtliff ME, Bergquist SC, Calhoun J. Antimicrobial treatment of chronic osteomyelitis. Clin. Orthop 1999b; 360 : 47 – 65
6. Waldvogel FA, Medoff G, Swartz MM. Osteomyelitis: A review of clinical features, therapeutic considerations and unusual aspects (three parts) NEJM 1970; 282: 198 – 206, 260 – 266, 316 – 322.
7. Lateef Mousa HA. Evaluation of sinus track cultures in chronic bone infection J. Bone Joint Surg. 1997; 79 B: 567 – 9.
8. Stratton C W. Microbiologic evaluation of Patients with skeletal infections. In Ambrasia Robert DD, Marrier RL (eds). Orthopedic Infections. 1st Indian edition A.I.T.B.S., New Delhi 2001: 309 – 320.
9. Vandepitte J, Engback K, Poit P, Heute CC. Basic laboratory procedures in clinical bacteriology World Health Organisation, Geneva 1991 : 21 – 25NCCLS guidelines (2002
10. Bauer AW, Kirby WMM, Sherris JC, Turck M. Antibiotic susceptibility testing by standardized single disc method . Am J Clin Path 1966; 45 : 493-96
11. Lazzarini L, De Lalla F, Mader JT. Long bone osteomyelitis. Curr. Infeet Dis Rep 2002; 4 : 439 – 45.
12. Bouza E. Munoz P. Micro organisms responsible for osteoarticular infections. Baillires Best Pract. Res. Clin. Rheumatol 1999 ;13: 21 – 35.
13. Fitzgerald RH Jr., Kelly PJ. Bacterial osteomyelitis. In: Braudy AJ, Davis C., Ferrira J (eds) Infectious diseases and Medical Microbiology2nd edition W. B. Saunders. 1986, 1472 –77.
14. Kelly PJ, Martin WJ, Coventry MB. Chronic osteomyelitis II: Treatment with closed irrigation and suction. JAMA 1970; 213: 1843 – 49.
15. Perry CR, Pearson RL. Miller GA. Accuracy of culture of material from swabbing of the superficial aspect of the wound and needle biopsy in pre-operative assessment of osteomyelitis. J Bone and Joint Surg 1999; 73-A : 745 –49.
16. Darouiche RO, Landon GC, Marcella Daniel KMM, Markavaski J, Osteomyelitis associated with pressure sores. Arch intern med 1994;154 : 753 – 8.
17. Brook I. Anaerobic osteomyelitis in children. Pediatr Infect Dis 1986;5: 550 – 6.
18. Patzakis MJ, Wileins J, Kumar J et al. Comparison of the results of bacterial cultures from multiple sites in chronic osteomyelitis of long bones: a prospective study J. Bone Joint Surg (Am) 1994 ; 76 : 664 – 6.
19. Burri C. Post traumatic osteomyelitis. Bern, Hans Huber Medical Publisher, 1975.
20. Brook I. Anaerobic osteomyelitis in children. Pediatr Infect Dis 1986;5: 550 – 6.
21. Fitzgerald RH Jr., Nolan DR., Ilstrup DM, Vansoy, RE, et al. Deep wound sepsis following total hip arthoplasty. J. Bone Joint Surg 1977; 59A : 784.
22. Mackowiack PA, Jones SR, Smith JW. Diagnostic value of sinus tract cultures in chronic osteomyelitis JAMA 1978; 239: 2772 – 5.
23. Dubey L, Kransinski K, Hernanz–Schulman Marta. Osteomyelitis secondary to trauma or infected contiguous tissue. Pediatr. Infect Dis J. 1988; 7: 26 – 33.
24. Cierny G, Mader JT, Penninck JJ. A clinical staging system for adult osteomyelitis. Clin Orthop 2003; 414: 7 – 21.
25. Mader JT, Calhoun JC. Osteomyelitis. In Mendell, Doughlas and Bennett (eds). Principle and Practice of Infectious diseases 3rd edition
1995. Churchill Livingstone, New York :1039 – 50.
26. Wald ER. Risk factors for osteomyelitis Am J Med 1985;78 (Suppl 6 B) : 206 – 12
