Evidence-based Medicine: Time for a change? - Journal of Medical ...

ORIGINAL ARTICLE
Among the gram negative organisms, both the
Pseudomonas aeruginosa and Acinetobacter
baumannii isolates were sensitive to Amikacin,
Table 1: Number and types of bacteria from positive
cultures
Bacteria Organism Osteomyelitis
n=19
Gram positive S.aureus 13
(68.3)
CONS 04
(21.1)
Total 17
(89.4)
Gram negative Pseudomonas aeruginosa 01
(5.3)
Acinetobacter baumanii 01
(5.3)
Total 02(10.6)
*Figures in parentheses indicate the percentage
Table 2: Antimicrobial susceptibility pattern of Grampositive
bacteria
Antibiotics Staphylococcus CONS
aureus (n=13)
(n=04)
S I R S I R
Erythromycin 10 00 3 3 00 1
(76.9) (23.1) (75) (25)
Gentamicin 8 00 5 3 00 1
(61.5) (38.5) (75) (25)
Ciprofloxacin 9 00 4 1 1 2
(69.2) (30.8) (25) (25) (50)
Piperacillin- 7 1 5 3 00 1
tazobactam (53.8) (7.7) (38.5) (75) (25)
Vancomycin 13 00 00 4 00 00
(100) (100)
Cefotaxime 6 03 4 1 1 2
(46.1) (23.1) (30.8) (25) (25) (50)
Oxacillin 00 00 13 00 00 04
(100) (100)
*Figures in parentheses indicate the percentage
Gentamicin, Piperacillin-tazobactam.
The isolates showed resistance to
Ceftazidime, Ceftriaxone, Ciprofloxacin and
Co-trimoxazole.
Discussion: According to Resnick D 7 , the
distribution of osteomyelitis is greatly
influenced by the age of the patient, the
specific causative organism and the presence
or absence of any underlying disorder or
situation. In this study, the maximum patients
belong to the age group of 0-15 years. In all
the age groups, males (66.7%) were
predominant over the females (33.3%)
comparable to a study by Waldvogel FA et al 8
and Duthie and Nelson. 9
The maximum number of cases of
osteomyelitis was seen in the summer
months of April to July which constituted more
than half the total number of cases. A similar
finding was reported by Mukhopadhyay B 10
wherein it was stated that osteomyelitis was
more common in summer and rainy seasons.
A culture positivity rate of 52% was observed
in this study, consistent with findings of
Vishwakarma and Lal 11 and Kundsen and
Hoffman 12 . In this study, majority of the
isolates were gram- positive organisms
(89.4%). Gram-negative organisms
constituted 10.6%. Mixed infection was seen
in 2 cases.
Staphylococcus aureus (68.3%) was the
commonest isolate comparable to studies by
Gupta U and Bhattacharya AN 13 Ng
Brajachand et al 14 and Dhawan et al 15 .
However the relative rates of Staphylococcus
aureus vary from centre to centre. Classen
et al 16 reported as low as 16.3%.
Staphylococcus aureus and Staphylococcus
epidermidis are the 2 major pathogens
responsible for most cases of osteomyelitis
in the present study.
There was no isolation of anaerobes. It could
probably due to the fact that anaerobic
organisms require very stringent conditions
for isolation and transportation which could
not always be maintained.
Consistent susceptibility (100%) to
Vancomycin is retained in this study. Most of
the isolates of Staphylococcus were sensitive
to Erythromycin. All the Staphylococcal
isolates showed resistance to methicillin.
Onche I and Adedeji O 17 also reported
Staphylococcus aureus completely resistant
to oxacillin in a hospital setting and inferred
that this was not unconnected with abuse of
antibiotics by the populace related to over the
counter selling of antibiotics.
44 JMS * JMS Vol 25 * Vol * No. 25 3 * No. * September, 1 * June, 2010 2011