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. 2010 Aug;468(8):2107-12.
doi: 10.1007/s11999-010-1271-2.

Microbiology of bone and joint infections in injecting drug abusers

Daniel C Allison  1 , Paul D Holtom, Michael J Patzakis, Charalampos G Zalavras
Affiliations

Microbiology of bone and joint infections in injecting drug abusers

Daniel C Allison et al. Clin Orthop Relat Res. 2010 Aug.

Abstract

Background: The literature contains variable reports on the causative organisms of osteomyelitis and septic arthritis in patients with injecting drug abuse and on the rate of oxacillin-resistant S aureus. It is important to have a clear notion of the organisms to initiate empiric antimicrobial therapy.

Questions/purposes: We therefore determined the spectrum of organisms in bone and joint infections in patients who were injecting drug users.

Methods: We retrospectively reviewed the medical records of 215 patients (154 male, 61 female) with a history of injecting drug abuse and concurrent bone and/or joint infection from 1998 to 2005. The mean age was 43 years (range, 23-83 years). Osteomyelitis was present in 127 of the 215 patients (59%), septic arthritis in 53 (25%), and both in 35 (16%). The lower extremity was most commonly involved (141 cases, 66%), with osteomyelitis of the tibia present in 70 patients (33%) and septic knee arthritis in 30 patients (14%).

Results: Cultures yielded predominately Gram-positive bacteria: Staphylococcus aureus in 52% and coagulase-negative Staphylococcus in 20%. The proportion of oxacillin-resistant S aureus among S aureus infections increased from 21% in 1998 to 73% in 2005. Gram-negative organisms were present in 19% of infections and anaerobes in 13%. Patients with osteomyelitis had a higher prevalence of polymicrobial infections (46% versus 15%), infections due to Gram-negative organisms (24% versus 9%), and anaerobic infections (19% versus 6%) compared to patients with septic arthritis.

Conclusions: These findings suggest broad-spectrum empiric antibiotic therapy, including vancomycin, should be considered for bone and joint infections in patients with injecting drug abuse.

Level of evidence: Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1
Fig. 1
A graph shows the progressive increase of ORSA isolates expressed as the percentage of S aureus infections during the time period of the study.
See this image and copyright information in PMC

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