Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.
Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK; Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals, Cambridge, UK.
J Infect. 2019 Sep;79(3):189-198. doi: 10.1016/j.jinf.2019.07.006. Epub 2019 Jul 15.
This study quantified changes in the microbiology of osteomyelitis over a ten year period from a single centre within the UK with regard to infection with multi-drug resistant (MDR) bacteria and susceptibility of antimicrobial regimens.
Patients with chronic osteomyelitis undergoing definitive surgery from 2013-2017 were inluded (n = 223). Microbiology was compared to patients in a cohort from 2001-2004, using the same diagnostic criteria, and same deep tissue sampling technique (n = 157). Clinical features associated with MDR bacterial infection were analysed using logistic regression.
Both cohorts had similar baseline characteristics. Despite a similar proportion of Staphylococcus aureus in both cohorts, the rate of methicillin resistant Staphylococcus aureus (MRSA) infection was lower in 2013-2017 compared to 2001-2004 (11.4% vs 30.8% of Staphylococcus aureus, p = 0.007). However, the proportion of MDR infections was similar in both cohorts (15.2% versus 17.2%). Metalwork was associated with MDR infection (unadjusted OR 5.0; 95% CI: 1.15 to 22.0). There was no change in resistance to glycopeptide / meropenem combination treatment (2.2% vs 2.5%, p > 0.9).
In this centre, rates of MRSA osteomyelitis have fallen by two thirds, over the past 10 years, in line with the reducing rate of MRSA bacteraemia nationally. A history of metalwork may predict MDR infection. A glycopeptide with an anti-pseudomonal carbapenem remains the post-operative empiric systemic regimen of choice. Resistance patterns support the use of a glycopeptide with an aminoglycoside in local antibiotic therapy.
本研究定量分析了英国某单一中心在过去十年间骨髓炎微生物学的变化，涉及耐多药（MDR）细菌感染和抗菌方案敏感性。
纳入 2013-2017 年接受确定性手术的慢性骨髓炎患者（n=223）。使用相同的诊断标准和相同的深部组织采样技术，将这些患者的微生物学数据与 2001-2004 年的队列患者（n=157）进行比较。使用逻辑回归分析与 MDR 细菌感染相关的临床特征。
两组患者的基线特征相似。尽管两组金黄色葡萄球菌的比例相似，但 2013-2017 年耐甲氧西林金黄色葡萄球菌（MRSA）感染率低于 2001-2004 年（金黄色葡萄球菌的 MRSA 感染率分别为 11.4%和 30.8%，p=0.007）。然而，两组的 MDR 感染率相似（15.2%比 17.2%）。金属植入物与 MDR 感染相关（未调整的 OR 5.0；95%CI：1.15 至 22.0）。糖肽/美罗培南联合治疗的耐药率无变化（2.2%比 2.5%，p>0.9）。
在本中心，过去 10 年间，MRSA 骨髓炎的发生率下降了三分之二，与全国范围内 MRSA 菌血症的下降速度一致。金属植入物的病史可能预示着 MDR 感染。糖肽类药物联合抗假单胞菌碳青霉烯类药物仍然是术后经验性全身治疗方案的首选。耐药模式支持在局部抗生素治疗中使用糖肽类药物联合氨基糖苷类药物。
