Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, Universidade de São Paulo, SP, Brazil.
Braz J Infect Dis. 2012 Jan-Feb;16(1):63-7.
Despite the growing interest in the study of Gram-negative bacilli (GNB) infections, very little information on osteomyelitis caused by GNB is available in the medical literature.
To assess clinical and microbiological features of 101 cases of osteomyelitis caused by GNB alone, between January 2007 and January 2009, in a reference center for the treatment of high complexity traumas in the city of São Paulo.
Most patients were men (63%), with median age of 42 years, affected by chronic osteomyelitis (43%) or acute osteomyelitis associated to open fractures (32%), the majority on the lower limbs (71%). The patients were treated with antibiotics as inpatients for 40 days (median) and for 99 days (median) in outpatient settings. After 6 months follow-up, the clinical remission rate was around 60%, relapse 19%, amputation 7%, and death 5%. Nine percent of cases were lost to follow-up. A total of 121 GNB was isolated from 101 clinical samples. The most frequently isolated pathogens were Enterobacter sp. (25%), Acinetobacter baumannii (21%) e Pseudomonas aeruginosa (20%). Susceptibility to carbapenems was about 100% for Enterobacter sp., 75% for Pseudomonas aeruginosa and 60% for Acinetobacter baumannii.
Osteomyelitis caused by GNB remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.
尽管人们对革兰氏阴性杆菌（GNB）感染的研究兴趣日益浓厚，但医学文献中关于 GNB 引起的骨髓炎的信息却很少。
评估 2007 年 1 月至 2009 年 1 月期间，在圣保罗市一家高复杂度创伤治疗的参考中心，101 例单独由 GNB 引起的骨髓炎的临床和微生物学特征。
大多数患者为男性（63%），中位年龄为 42 岁，患有慢性骨髓炎（43%）或急性骨髓炎合并开放性骨折（32%），大多数为下肢（71%）。患者接受抗生素治疗，住院 40 天（中位数），门诊治疗 99 天（中位数）。6 个月随访后，临床缓解率约为 60%，复发 19%，截肢 7%，死亡 5%。9%的病例失访。从 101 例临床标本中分离出 121 株 GNB。最常分离的病原体是肠杆菌属（25%）、鲍曼不动杆菌（21%）和铜绿假单胞菌（20%）。肠杆菌属对碳青霉烯类的敏感性约为 100%，铜绿假单胞菌为 75%，鲍曼不动杆菌为 60%。
由 GNB 引起的骨髓炎仍然是一个严重的治疗挑战，特别是当与非发酵菌相关时。我们强调需要在诊断为骨髓炎的病例中考虑这些药物，以便从治疗开始就给予理想的抗菌治疗。
