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Polymicrobial osteomyelitis: report of three cases and review of the literature
Abstract:
Five percent of patients with acute osteomyelitis and 30%-60% of patients with chronic osteomyelitis have polymicrobial infections. Three illustrative cases and a review of the literature involving 104 patients are presented in this report. There were 2.4 isolates per child among the 31 pediatric cases ad 3.9 isolates per adult among the 71 adult cases reviewed. Staphylococcus aureus was the single most common isolate involved in polymicrobial disease in both adults and children. In adults, one-third of the aerobic isolates were gram-negative bacterial species; some enterococci were also involved. Of the isolates from adults, 46% were anaerobic. The number of isolates per case was similar for the acute (3.2) and chronic (3.1) forms of infection. Polymicrobial osteomyelitis resulted most frequently from spread of infection from a contiguous focus (59% of cases) or occurred in the patient with peripheral vascular insufficiency or neuropathy (17% of cases); however, the hematogenous route can produce polymicrobial disease (13% of cases). Bones mot often involved are those of the skull, face, and feet. Standard antibiotic therapy for monomicrobial osteomyelitis with semisynthetic penicillins or cephalosporins may lead to failures of treatment in polymicrobial disease.
Insights
Polymicrobial osteomyelitis, involving multiple bacteria, is common in chronic cases. Standard antibiotic treatments may fail, necessitating tailored approaches for these complex bone infections.
Area of Science:
- Infectious Diseases
- Microbiology
- Orthopedic Surgery
Background:
- Polymicrobial infections are prevalent in both acute (5%) and chronic (30%-60%) osteomyelitis.
- Understanding the microbial spectrum and routes of infection is crucial for effective treatment.
Observation:
- A literature review of 104 patients (31 pediatric, 71 adult) revealed an average of 2.4 isolates per pediatric case and 3.9 per adult case.
- Staphylococcus aureus was the most frequent isolate in both age groups.
- Gram-negative species and anaerobes were significant components of adult polymicrobial isolates.
Findings:
- The number of bacterial isolates per case was similar for acute (3.2) and chronic (3.1) osteomyelitis.
- Contiguous spread (59%) and peripheral vascular disease/neuropathy (17%) were primary sources of infection.
- Hematogenous spread accounted for 13% of polymicrobial cases.
Implications:
- Standard antibiotic regimens for monomicrobial osteomyelitis may be inadequate for polymicrobial cases.
- Treatment strategies must consider the diverse microbial profiles and origins of polymicrobial osteomyelitis.
- Further research into targeted antimicrobial therapies for polymicrobial bone infections is warranted.
