The microbiology of chronic osteomyelitis: prevalence of resistance to common empirical anti-microbial regimens.
Sheehy SH., Atkins BA., Bejon P., Byren I., Wyllie D., Athanasou NA., Berendt AR., McNally MA.
This study describes the microbiological spectrum of chronic osteomyelitis and so guides the choice of empirical antibiotics for this condition.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.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.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.