Devi, C (2013) A Study on Bacterial and Fungal Isolates and their Antimicrobial susceptibility pattern in patients with Chronic Osteomyelitis in a Tertiary Care Hospital. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : The word Osteomyelitis is a combination of Greek word “Osteon” Meaning bone and “Myelos” meaning marrow plus the suffix “Itis” meaning Inflammation. Osteomyelitis is acquired in three ways. They are direct seeding of Microorganisms into bone due to trauma or surgery, haematogenous spread of Microorganisms from the focus of infection elsewhere in the body and spread From surrounding infected soft tissues and joints In the infected bone, the infection may be unifocal or multifocal. In Unifocal involvement, only a single region of t he bone is affected. In Multifocal involvement, more than one region of bone such as marrow, Periosteum, cortex and the surrounding so ft tissue are involved. Commonly t he infect ion is mono microbial. Infect ion due to multiple Organisms are usually seen in patients with Diabetes mellitus with ulcer In the foot. Chronic Osteomyelitis of long bones is often the consequence of an Open, comminuted fracture and inadequately treated infect ion of the fracture site. Rarely it occurs as a complication of acute osteomyelit is now-a-days. The pattern and behaviour of organisms are constantly changing under the pressure of newer antibiotics .As a result the wonder drugs of fifties have been relegated to a position of limited usefulness today. With this background, it is felt worthwhile to study the spectrum of organisms Causing osteomyelitis and their antimicrobial susceptibility pattern. AIM OF THE STUDY : To study the predisposing factors associated with chronic Osteomyelitis. To study the causative organisms and their antimicrobial susceptibility pattern. To study the resistance pattern in common isolates. MATERIALS AND METHODS : The necessary ethical committee approval was obtained before the commencement of the study. Informed consent was obtained from the study population. All patients satisfying the inclusion criteria were documented. Patients were interviewed by structured questionnaire. Inclusion Criteria : Patients older than 12 years. Patients admitted in orthopaedic wards and those attending outpatient department who satisfy one of the following six components of chronic osteomyelitis. Osteomyelitis in association with trauma only. Osteomyelitis in association with diabetes and peripheral vascular compromise. Clinical evidence of chronic disease. (Eg. Mycobacterium tuberculosis). Radiological changes suggestive of infection for 6 weeks or more. Formation of sequestrum or sclerosis. Even after treatment, persistence or relapse of infection. Exclusion Criteria : Patients with prosthetic orthopaedic implants devices. Paediatric age group (<12 years). Name, age, sex, date of admission, physical examination findings, history of trauma, associated predisposing factor (diabetes mellitus, intravenous drug abuse, immunosuppression, tuberculosis) duration of illness, smoking and alcoholism were also recorded. CONCLUSION : This study on 120 patients admitted in orthopaedic wards and those attending outpatient department, Rajiv Gandhi Government General Hospital, Chennai with Chronic osteomyelitis was conducted to study the Predisposing factors, Etiological agents, Antimicrobial Susceptibility Pattern and Drug resistance pattern among the isolates. Trauma especially road traffic accident with open fracture has been found to be the major predisposing factor. Open fractures leading to Osteomyelitis depends on the type of fracture, the level of contamination, the degree of soft tissue injury and whether local and systemic antimicrobial therapies have been administered. Additional predisposing factors include Post surgical conditions, Diabetesmellitus, Smoking and Alcoholism. The above predisposing factors leads to chronicity of infection, delayed healing and exposure to prolonged antibiotic therapy, resulting in the overgrowth of resistant strains. 56.6% were Aerobic gram positive cocci and 43.3% were Aerobic gram negative bacilli. Among Gram positive cocci, Staphylococcus aureus (36.7%) was the commonest pathogen isolated followed closely by Staphylococcus epidermidis (10.5%).All gram positive cocci except one were sensitive to Vancomycin and Rifampin. Among gram negative bacilli, all were sensitive to Imipenem and 90% to Cefoperazone sulbactum. Pseudomonas had lower sensitivity (76.4%) to Cefoperazone. Multidrug resistance was seen in 40.5% of isolates from chronic Osteomyelitis cases. This factor stresses the need for culture and sensitivity and choosing appropriate narrow spectrum antibiotic for prolonged therapy (6 weeks). Also, the choice of empirical antibiotics, should be based both on prevalence of local pathogen and antimicrobial susceptibility and on the identification of patient with high risk of developing infections caused by multidrug resistant organism. As there are various factors in open fracture leading to chronic Osteomyelitis ,each patient has to be routinely monitored after trauma and treatment for developing Osteomyelitis. Treatment given in the early stage will prevent dreadful complications and sequelae.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Bacterial ; Fungal Isolates ; Antimicrobial susceptibility pattern ; patients ; Chronic Osteomyelitis ; Tertiary Care Hospital. |
| Subjects: | MEDICAL > Microbiology |
| Depositing User: | Subramani R |
| Date Deposited: | 02 Aug 2017 02:35 |
| Last Modified: | 02 Aug 2017 02:35 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1742 |
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