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Is vancomycine still a choice for chronic osteomyelitis empirical therapy in iran?

Morteza Izadi1, Mohammad Mahdi Zamani, Seyed Ahmad Mousavi

  • 1Health Research Center (HRC), Baqiyatallah University of Medical Sciences, Tehran, IR Iran.

Iranian Red Crescent Medical Journal
|March 14, 2013
PubMed
Abstract

Insights

Antibiotic resistance in Staphylococcus aureus is a significant challenge in chronic osteomyelitis treatment. The E-test is more reliable than disk diffusion for determining Vancomycin susceptibility, with no Vancomycin-resistant strains detected in Iranian patients.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Chronic osteomyelitis is primarily caused by pyogenic bacteria, particularly Staphylococcus aureus.
  • Treatment of chronic osteomyelitis is often challenging due to difficult-to-treat infections.

Purpose of the Study:

  • To investigate the antibiotic resistance patterns of Staphylococcus aureus in Iranian patients with chronic osteomyelitis.
  • To compare the efficacy of disk diffusion (Kirby-Bauer) and E-test methods for determining antibiotic susceptibility and Minimum Inhibitory Concentration (MIC).

Main Methods:

  • Culturing of infection sites from 131 chronic osteomyelitis patients.
  • Antibiotic susceptibility testing and MIC determination using Kirby-Bauer disk diffusion and E-test.
  • Focus on Vancomycin susceptibility and identification of Methicillin-resistant S. aureus (MRSA) and Vancomycin-resistant S. aureus (VRSA).

Main Results:

  • Staphylococcus aureus was isolated from 49.6% of samples.
  • MRSA prevalence was 75% by disk diffusion and 68.5% by MIC.
  • No Vancomycin-resistant S. aureus (VRSA) strains were detected.
  • Vancomycin showed high sensitivity (90.2% by MIC, 97.7% by disk diffusion).
  • E-test demonstrated higher intermediate susceptibility to Vancomycin (9.8%) compared to disk diffusion (2.3%).

Conclusions:

  • The E-test is more reliable than the Kirby-Bauer disk diffusion method for detecting Vancomycin-Intermediate S. aureus (VISA) strains.
  • The absence of VRSA in this cohort suggests Vancomycin remains a primary empirical treatment choice for chronic osteomyelitis in Iran.
Keywords:
IranMethicillin-ResistantOsteomyelitisStaphylococcus AurousVancomycin Resistance

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