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Archives of Orthopaedic and Trauma Surgery

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22-12-2023 | Osteomyelitis | Trauma Surgery

Etiology and antimicrobial resistance patterns in chronic osteomyelitis of the tibia: an 11-year clinical experience

Authors: Carla Carbonell-Rosell, Kushal Lakhani, Mayli Lung, Patricia Nadal, Dolors Rodriguez-Pardo, Pablo S. Corona

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2024

Abstract

Purpose

To analyze changes in tendency of etiology and of antimicrobial resistance patterns to most common local and systemic antibiotics in chronic osteomyelitis of the tibia (COM-T) in a Level I trauma center over an 11-year period.

Methods

A retrospective review including all patients with COM-T who were surgically treated from January 2009 to December 2019. Patients were divided into two period groups: 2009–2014 and 2015–2019. Microbiologic etiology was analyzed. Bacterial resistance patterns evaluation was based on the Magiorakos et al. classification, including proportions of multidrug-resistant organisms (MDROs, acquired non-susceptibility to at least one agent in three or more antimicrobial categories), extensively drug-resistant (XDR) and pan drug-resistant (PDR) organisms encountered.

Results

A total of 173 episodes of COM-T were identified. Monomicrobial infections represented 47.4% of all cases, while 28.3% had polymicrobial infections. Negative deep-bone cultures were identified in 24.3% of the patients. The most commonly isolated microorganisms were coagulase-negative Staphylococci (24.5%) and S. aureus (20.5%). No differences were found when comparing Gram-positive infections between periods (58.3% for 2009–2014 vs. 46.7% for 2015–2019; p = 0.10). Findings were similar for Gram-negative infections (37% vs. 33.7%; p = 0.62), although more polymicrobial infections were detected (24.7% vs. 33.3%, respectively; p = 0.359). MDROs were involved in 15% of the cases, with an upward trend when comparing both periods (12.8% vs. 23.6%; p = 0.07). The most-used combination of local antibiotics—glycopeptide (vancomycin) plus aminoglycoside (gentamicin or tobramycin)—was met with low rates of resistance in the most frequently isolated microorganisms.

Conclusion

According to the results of the present study, rates of Gram-positive and Gram-negative infections remained consistent during the two study periods, but with an upward trend in MDRO and polymicrobial infections detected. The local combination of a glycopeptide plus an aminoglycoside was effective in treating the most frequently isolated microorganisms.

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Title: Etiology and antimicrobial resistance patterns in chronic osteomyelitis of the tibia: an 11-year clinical experience
Authors: Carla Carbonell-Rosell
Kushal Lakhani
Mayli Lung
Patricia Nadal
Dolors Rodriguez-Pardo
Pablo S. Corona
Publication date: 22-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Osteomyelitis
Antibiotic
Tobramycin
Gentamicin
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2024
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-05095-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Etiology and antimicrobial resistance patterns in chronic osteomyelitis of the tibia: an 11-year clinical experience

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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