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Microbiology of bone and joint infections in injecting drug abusers
Daniel C Allison1, Paul D Holtom, Michael J Patzakis
1Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, LAC + USC Medical Center, 1200 N State Street, GNH 3900, Los Angeles, CA 90033, USA.
Background:
The literature contains variable reports on the causative organisms of osteomyelitis and septic arthritis in patients with injecting drug abuse and on the rate of oxacillin-resistant S aureus. It is important to have a clear notion of the organisms to initiate empiric antimicrobial therapy.
Questions/Purposes:
We therefore determined the spectrum of organisms in bone and joint infections in patients who were injecting drug users.
Methods:
We retrospectively reviewed the medical records of 215 patients (154 male, 61 female) with a history of injecting drug abuse and concurrent bone and/or joint infection from 1998 to 2005. The mean age was 43 years (range, 23-83 years). Osteomyelitis was present in 127 of the 215 patients (59%), septic arthritis in 53 (25%), and both in 35 (16%). The lower extremity was most commonly involved (141 cases, 66%), with osteomyelitis of the tibia present in 70 patients (33%) and septic knee arthritis in 30 patients (14%).
Results:
Cultures yielded predominately Gram-positive bacteria: Staphylococcus aureus in 52% and coagulase-negative Staphylococcus in 20%. The proportion of oxacillin-resistant S aureus among S aureus infections increased from 21% in 1998 to 73% in 2005. Gram-negative organisms were present in 19% of infections and anaerobes in 13%. Patients with osteomyelitis had a higher prevalence of polymicrobial infections (46% versus 15%), infections due to Gram-negative organisms (24% versus 9%), and anaerobic infections (19% versus 6%) compared to patients with septic arthritis.
Conclusions:
These findings suggest broad-spectrum empiric antibiotic therapy, including vancomycin, should be considered for bone and joint infections in patients with injecting drug abuse.
Level Of Evidence:
Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
Insights
Bone and joint infections in injecting drug users are often caused by Staphylococcus aureus, with a significant rise in oxacillin-resistant strains. Empiric antibiotic therapy should be broad-spectrum to cover these common pathogens.
Area of Science:
- Infectious Diseases
- Orthopedics
- Microbiology
Background:
- Injecting drug abuse is associated with a high risk of osteomyelitis and septic arthritis.
- Causative organisms and resistance patterns for these infections vary, impacting empiric treatment decisions.
Purpose of the Study:
- To determine the spectrum of microorganisms responsible for bone and joint infections in patients with a history of injecting drug abuse.
Main Methods:
- Retrospective review of 215 patients with injecting drug abuse and bone/joint infections (1998-2005).
- Analysis of infection sites, including osteomyelitis and septic arthritis, with a focus on microbial pathogens.
- Evaluation of pathogen prevalence, including Gram-positive bacteria, Gram-negative organisms, and anaerobes.
Main Results:
- Staphylococcus aureus was the predominant pathogen (52%), followed by coagulase-negative Staphylococcus (20%).
- Oxacillin-resistant Staphylococcus aureus (ORSA) rates increased significantly from 21% in 1998 to 73% in 2005.
- Osteomyelitis cases showed a higher incidence of polymicrobial (46%), Gram-negative (24%), and anaerobic (19%) infections compared to septic arthritis.
Conclusions:
- Findings indicate a need for broad-spectrum empiric antibiotic therapy for bone and joint infections in injecting drug users.
- Vancomycin should be considered in empiric regimens due to the high prevalence of Staphylococcus aureus and increasing ORSA rates.
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