The microbiology of musculoskeletal infection

Of paramount importance in the isolation and identification of bacteria, including mycobacteria, and fungi that cause musculoskeletal infections, are proper selection, collection, and transport of specimens. Material obtained by biopsy, curettage, or aspiration is preferable to that obtained on a swab because too little or unrepresentative material is usually collected on a swab and because swabs cannot be transported readily under conditions favorable to survival of anaerobes. Although actual infections are frequently due to staphylococci, strepococci, Enterobacteriaceae, and Pseudomonadacease, the etiologic agents of chronic lesions may include actinomycetes, brucellae, mycobacteria, and fungi. In chronic lesions, histopathologic examination of biopsy material is an important ancillary procedure. In acute infections, the incidence of gram-negative bacilli, particularly of Enterobacteriaceae and pseudomonads, has increased significantly in recent years.