Vemu Lakshmi, Sudhaharan Sukanya, Mamidi Neeraja, Chavali Padmasri
Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
J Lab Physicians. 2018 Jan-Mar;10(1):21-25. doi: 10.4103/JLP.JLP_14_17.
Chronic osteomyelitis (COM) is a common infection, especially in developing countries. An adequate bone biopsy specimen processed with appropriate microbiology culture methods for isolation and identification of the causative organisms is considered as the gold standard for the diagnosis of osteomyelitis.
The present study is a retrospective microbiology analysis of the specimen from 219 clinically diagnosed cases of COM between January 2013 and April 2016.
The overall culture positivity was 111/219 (50. 6%), colonization was seen in 22/219 (10.5%), while the rest 86/219 (39.3%) were culture-negative specimen; culture positivity was highest from tissue specimen (71/113, 62.8%). Among the swabs, 40/106 (37.7%) were culture positive. About 28/40 (70%) culture-positive swabs showed significant growth of Gram-positive organisms. Colonization with skin flora such as diphtheroids and Coagulase-negative was seen in 22/106 (20.7%) of the swabs. Sterile cultures (44/106, 41.6%) were high among the swab specimen. Gram-positives were most common (75/111, 67.56%). was the predominant organism isolated in 70/111 (63%) cases. Gram-negative bacilli showed a high level of antibiotic resistance.
As per our data, the culture yield from wound swabs was low or contaminated with normal skin flora, as compared to the biopsy or tissue specimen. Hence, an appropriate sampling of the infected bone using recommended protocols is highly essential for improving microbiological yield and the outcome of COM.
慢性骨髓炎（COM）是一种常见的感染性疾病，在发展中国家尤为常见。通过适当的微生物培养方法处理足够的骨活检标本以分离和鉴定病原体，被认为是骨髓炎诊断的金标准。
本研究是对2013年1月至2016年4月间219例临床诊断为COM的病例标本进行的回顾性微生物学分析。
总体培养阳性率为111/219（50.6%），定植率为22/219（10.5%），其余86/219（39.3%）为培养阴性标本；组织标本的培养阳性率最高（71/113，62.8%）。在拭子中，40/106（37.7%）培养阳性。约28/40（70%）培养阳性拭子显示革兰氏阳性菌显著生长。22/106（20.7%）的拭子中可见皮肤菌群如类白喉杆菌和凝固酶阴性菌的定植。拭子标本中无菌培养（44/106，41.6%）的比例较高。革兰氏阳性菌最为常见（75/111，67.56%）。在70/111（63%）的病例中， 是分离出的主要病原体。革兰氏阴性杆菌显示出较高水平的抗生素耐药性。
根据我们的数据，与活检或组织标本相比，伤口拭子的培养阳性率较低或被正常皮肤菌群污染。因此，使用推荐方案对感染骨进行适当采样对于提高微生物学阳性率和慢性骨髓炎的治疗效果至关重要。
