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PubMed2026

Genomic insights into preantibiotic osteomyelitis pathogens and their link to current resistant hospital strains.

OBJECTIVES: Osteomyelitis is a severe bone infection that was frequently fatal before the introduction of antibiotics and remains a significant healthcare burden today. Staphylococcus aureus is the most common cause, alongside other hospital-acquired pathogens. Despite their clinical importance, the evolutionary history of these bacteria remains poorly understood. We investigated historical osteomyelitis specimens to identify causative pathogens and characterise their genomes, virulence and antimicrobial resistance (AMR). METHODS: Seven osteomyelitis-affected bones from adults dating to 19th-20th century Germany were analysed using ancient DNA (aDNA) approaches. After sequencing and screening, candidate pathogens were prioritised based on authentic aDNA damage patterns, established association with osteomyelitis and exclusion as environmental contaminants. Identified species were characterised by phylogenetics, multilocus sequence typing and virulence/AMR profiling. RESULTS: In four patients, we detected authentic aDNA from Acinetobacter baumannii, S. aureus or Streptococcus pyogenes. Detected taxa in the remaining three patients did not fulfil the criteria for further analysis. Two patients carried A. baumannii genomes clustering closely with modern avian and freshwater isolates. Both harboured virulence genes, alongside intrinsic efflux pumps and β-lactamases. One patient carried an S. aureus strain belonging to the globally disseminated clonal complex 30, responsible for outbreaks since the 1950s. Molecular dating indicated that this strain diverged from the wider lineage around 1800, placing it among the earliest members of this group. It encoded multiple virulence genes, but no methicillin resistance genes. The fourth patient carried an S. pyogenes strain related to modern epidemic lineages from North America, encoding conserved virulence factors, but no AMR genes. CONCLUSIONS: These specimens provide a window into the evolution of osteomyelitis pathogens. Although modern developments such as widespread antibiotic use have intensified the global resistance crisis, our findings indicate that the genetic foundations for pathogenicity and resistance were already present more than 100 years ago.

Ancient DNA↗

PubMed1978

Diagnostic value of sinus-tract cultures in chronic osteomyelitis.

Sinus-tract cultures were compared with cultures of operative specimens from 40 patients with chronic osteomyelitis. Thirty-five patients (87.5%) had a single pathogen isolated from their operative specimens. Only 44% of the sinus-tract cultures contained the operative pathogen. Isolation of Staphyloccus aureus from sinus tracts correlated with the presence of S aureus in the operative specimen. However, less than half of the sinus-tract cultures obtained from patients with S aureus osteomyelitis contained this organism. Isolation of bacteria other than S aureus from sinus tracts had a low likelihood of predicting the pathogen isolated from bone. A presumptive diagnosis of S aureus osteomyelitis is justified if S aureus is isolated from an associated sinus tract. A bacteriologic diagnosis of chronic osteomyelitis based on isolation of common pathogens other than S aureus from sinus tracts must be verified by an appropriate operative culture.

Adolescent↗

PubMed1976

Arizona hinshawii osteomyelitis with antecedent enteric fever and sepsis. A case report with a review of the literature.

A case of Arizona osteomyelitis of the spine which occurred 11 months after an episode of gastroenteritis and enteric fever is presented. As close biochemical and antigenic relative of Salmonella, Arizona infection produces a similar clinical course with gastrointestinal manifestations frequently preceding localized infections by several months. The boney lesion in the present case and in three of the four other cases of Arizona osteomyelitis described in the literature was a chronic inflammation which may have a xanthomatous component. The bone destruction caused by Arizona infection is less severe than that of tuberculosis or pyogenic osteomyelitis. Proposed treatment of Arizona osteomyelitis consists of debridement of the localized infection and long term antimicrobial therapy.

Child, Preschool↗

PubMed1979

Pyogenic osteomyelitis of axial bones following civilian gunshot wounds.

A series of forty-five patients with low velocity gunshot wounds to the spine and pelvis were followed up for at least eight weeks to determine the incidence of pyogenic osteomyelitis and the role of debridement and fragment removal in its prevention. Four cases of osteomyelitis were found, and although debridement was not frequently done, the incidence of osteomyelitis was higher following debridement than it was without debridement. The most important cause appeared to be spread of contiguous intraabdominal abscesses into the injured paravertebral muscles and spine. If an intraabdominal abscess did not develop, the presence of gastrointestinal injury did not predispose the patient to osteomyelitis. Based on this study, we can conclude that debridement and fragment removal of the spine and pelvic bones are unnecessary for low velocity missile wounds.

Abscess↗

PubMed1979

The production of prostaglandins in response to experimentally induced osteomyelitis in rabbits.

Osteomyelitis was induced in the tibiae of rabbits by injection of staphylococcus aureus and sodium tetradecylsulphate (STD); additional rabbits were injected with STD alone. Confirmation of osteomyelitis was based on positive culture of the same phage type bacteria from the tibiae and on the characteristic radiographical and histological appearance of osteomyelitis. Only tibiae which proved to be infected by the above criteria showed significantly increased in vitro release and content of Prostaglandin E and Prostaglandin F2 alpha compared with tibiae injected with STD (P less than 0.05). After two weeks infection, infected tibiae released nine times more Prostaglandin E and five times more Prostaglandin F2 alpha than tibiae injected with STD alone. After four weeks infection, infected tibiae released less Prostaglandin E (P less than 0.05) than after two weeks infection but the release of Prostaglandin F2 alpha was similar. The production of large amounts of prostaglandins by bones in response to infection may be the cause of the rapid bone resorption and sequester formation observed in osteomyelitis.

Animals↗

PubMed1978

[Sympathetic arthritis. A contribution to plasma cell osteomyelitis (author's transl)].

Sympathetic arthritis is a sterile, non-pyogenic complication due to adjacent bone disease, particularly chronic inflammatory osteomyelitis. Radiologically it is manifested as an arthrosis or serous arthritis (painful effusion), or as a chronic destructive arthitis. In the latter case, there is a lymphatic and plasma cell synovitis which may persist, clinically and radiologically, for a period of months or years before definite radiological signs of a chronic osteomyelitis become apparent. Observations of patients with plasma cell osteomyelitis and chronic destructive sympathetic arthritis indicate a special set of findings due to plasma cell osteomyelitis: metadiaphyseal ossifying periostitis, extreme demineralisation of the adjacent epiphysis with spotty focal sclerosis of the spongiosa and a chronic arthritis.

Adult↗

PubMed1978

Anaerobic osteomyelitis.

We have presented eight case histories of patients with anaerobic osteomyelitis and have reviewed an additional 193 cases from the world literature. The incidence, predisposing factors, clinical localization, bacteriology, modes of presentation and natural history of anaerobic osteomyelitis are discussed. This disease entity appears to be more common than has been previously recognized. Seven distinct clinical syndromes of anaerobic osteomyelitis are described and related to the anatomical locations in which they tend to occur. The signs and symptoms of these entities have been outlined to aid in their recognition by practitioners. An approach to the therapy of anaerobic osteomyelitis is outlined. Emphasis is placed on adequate surgical intervention combined with antimicrobial agents chosen for each particular clinical situation. The lack of definitive data upon which to base a decision regarding dosages and duration of antimicrobial therapy is discussed and the authors' own preferences enumerated.

Adolescent↗

PubMed1975

[Osteomyelitis of the jaw].

A brief description of nomenclature differences and classification principles is followed by a report of the results from an analysis of cases of osteomyelitis of the jaw which have been treatedduring the years 1967-1972. During this period, altogether 745 patients with soft-tissue infection and 72 patients with osteomyelitis have been treated at the clinic. The chronic form of osteomyelitis is considerably more frequent than the acute one. The odontogenic mode of infection prevails by far. The flora of causativeorganisms and the resistance conditions are dealt with separately. The mixed flora dominates; monoinfections are rare. Antibiotherapy occupies the first place in the treatment of the acute forms whereas surgical intervention is the method of choice in the treatment of the chronic forms of osteomyelitis.

Acute Disease↗

PubMed1975

Clindamycin treatment of osteomyelitis and septic arthritis in children.

Forty-eight children, 1 month to 14 years of age, including 11 patients with untreated acute osteomyelitis, 8 with pretreated acute osteomyelitis, 12 with septic arthritis, and 11 with cellulitis or soft tissue abscess, were treated with clindamycin. Staphylococcus aureus was isolated from the blood, synovial fluid, bone, or soft tissues of 27 of these individuals while group A, beta-hemolytic streptococci or Clostridia were isolated from 9 patients. Clindamycin was provided intravenously until patients were afebrile for three days followed by orally administered clindamycin for one week in patients with cellulitis to as long as six months in patients with chronic osteomyelitis. Clinical and bacteriologic responses to treatment generally were excellent, most likely reflecting the excellent serum and tissue concentrations of clindamycin which were achieved. Serum concentrations of clindamycin following intravenous infusion at 20 to 30 mg/kg/day in three divided doses were 8- to 32-fold in excess of the minimal inhibitory concentrations of all organisms isolated in this study. Bone and synovial fluid concentrations of clindamycin were 60% to 85% of the serum concentrations measured concomitantly. Clindamycin provides an effective alternative treatment of osteomyelitis and septic arthritis in children who are sensitive to penicillin.

Abscess↗

PubMedDate not supplied

Pediatric osteomyelitis: III. anaerobic microorganisms.

Primary osteomyelitis consequent to obligate anaerobic microorganisms represents an infrequently encountered type of infection in pediatric patients. Unlike osteomyelitis caused by more common microorganisms such as Staphylococcus, children with osseous lesions due to anaerobic microorganisms are frequently minimally symptomatic and rarely present the classic signs of fulminant osteomyelitis. Radiographically, the lesions may mimic malignant osseous tumors. Fastidious microbiologic analysis of the material obtained at surgery is necessary to isolate obligate anaerobes. Basic treatment, comprising surgical drainage and appropriate antimicrobial agents, does not differ from that for osteomyelitis caused by aerobic or by facultative anaerobic microorganisms.

Adolescent↗

PubMed1992

Confusion as the presenting manifestation of vertebral osteomyelitis: a case report.

A 44-year-old patient presented with increasing confusion. He was first diagnosed as having intermittent pressure hydrocephalus but a further evaluation showed CSF pleocytosis and hypoglycorrhachia. Five weeks later, his physical examination was unrevealing. Nuclear imaging techniques were conflicting, with negative gallium- and indium-labelled white blood cells scans but a Tc scan pointing towards a vertebral infection. A well-demarcated lesion in the T9 vertebral body, demonstrated by CT scan, confirmed the diagnosis of vertebral osteomyelitis. Although we were unable to recover the causative organism, antibiotic treatment for presumed staphylococcal osteomyelitis resulted in full recovery. This case indicates that vertebral osteomyelitis may cause significant meningeal inflammation even in the absence of epidural or subdural abscess. We recommend that in patients with meningitis without a clear etiology vertebral osteomyelitis should be considered and pursued with CT scannings of the vertebrae, a procedure that can yield positive findings even when other scanning modalities are negative.

Adult↗

PubMed1992

Chronic osteomyelitis of the mandible: case report.

Chronic osteomyelitis is a devastating disease of unknown etiology. The primary cause is usually thought to be microbiological. The diagnosis of osteomyelitis of the mandible is arduous, particularly in the early stages, and this disease is almost always difficult to cure. Clinical symptoms, radiographic changes and histologic findings are characteristic of this disease. Treatment modalities have been directed toward eradicating microbes and improving circulation, in the early stages. In the case presented, surgical debridement and IV antibiotics were the treatment of choice. The bone biopsy histopathology report in this case, revealed normal bone, which was inconsistent with chronic osteomyelitis. This article delves into the literature providing history and current research trends in the diagnosis, treatment and follow up care for chronic osteomyelitis.

Adult↗

PubMed1979

[An experimental study on pyogenic osteomyelitis with special reference to the analysis of the therapeutic effects of antibiotics in vivo (author's transl)].

Experimental osteomyelitis was produced in mice by the Ueno's method for the purpose of evaluating therapeutic effects of the antibiotics. The results were as follows: 1) Experimental osteomyelitis produced with penicillin-G sensitive bacteria was completely cured by PC-G 1.8 mg per mouse a day, which provided maintenance of the concentration in serum more than 10 times of MIC for over 12 hours. The dosis of 0.18 mg per mouse per day was insufficient to bring a complete healing. 2) Experimental osteomyelitis produced with penicillin-G resistant bacteria did not heal completely, despite the administration of MPI-PC, a synthetic penicillin designed against penicillin resistant staphylococci, in a dosis of 5 mg twice a day, probably by the following reasons. Since MPI-PC is water-soluble, it is difficult to maintain the concentration in serum more than 10 times of MIC for over 1 hour. In other word, the bacteria was exposed to the effective antibiotic concentration for only one hour twice a day. 3) It was experimentally proved that earlier administration of antibiotics following inoculation provided quicker elimination of bacteria. 4) When bactericidal antibiotics were used, administration twice a day in half dosis gave better results compared with the full dosis once a day. 5) This experimental model of osteomyelitis proved quite useful for quantitative analysis of the effects of antibiotics, which would be applicable as a good method for evaluation of antibiotics to be developed in the future.

Animals↗

PubMed1978

[The value of scintigraphy for the early detection of osteomyelitis (author's transl)].

For therapy and development of acute haematogenic osteomyelitis early detection of this disease is decisive. In our study 74 children were investigated scintigraphically with Tc-pyrophosphat because of suspicion of an inflammatory bone process. In all 23 cases of osteomyelitis scintigraphy showed an indication in form of increased activity in the respective bones; so the sensivity of this investigation, found in our study, was 1.0. In 10 of 51 cases without osteomyelitis scintigraphy, however, also showed increased activity. Because of this limited specifity of scanning further investigations are needed in the diagnosis of osteomyelitis. The main advantage of scintigraphy as compared with roentgen observation is the high sensitivity in the first days of illness. In addition scanning may supply valuable informations about the inflammatory process as long as it is active.

Child↗

PubMed1977

[Fistula carcinoma arising from chronic osteomyelitis (author's transl)].

224 cases of fistula carcinoma arising from chronic osteomyelitis from literature and 6 own observations are reviewed. This malignancy results in about 1,5% cases of chronic osteomyelitis. The mean age of all patients was 55.7 years. The sex relation male to female was 7.4:1. The time from the beginning of the chronic osteomyelitis up to the diagnosis of the fistula carcinoma was 33.6 years. This time is called "Exposition time". The analysis of this time shows that, the older the patient was at the beginning of the chronic osteomyelitis the shorter was the exposition time.

Adult↗

PubMed1976

[Osteomyelitis, therapy and prognosis (author's transl)].

The application of antibiotics at the treatment of osteomyelitis resulted in a rise of the permanent successful treatment rate. This is especially true for the acute hematogenous osteomyelitis, to a certain extent also for the chronic exogenous one, at which even today the antibiotical therapy is not as important as a surgical intervention. Under consideration of the generally accepted therapeutical principles the special importance of a much individualized treatment adjusted to the clinical picture and disease stage is pointed out. The advantages and disadvantages of an application of antibiotics at the osteomyelitis are mentioned and we try to explain the reasons for occasional therapy failures. A special chapter is devoted to the methods of filling and sterilization of the osteomyelitis bone hollows. Our own experiences with an operative combination process are reported.

Acid-Base Equilibrium↗

PubMed1978

Haemophilus influenzae type b osteomyelitis.

Three children had osteomyelitis due to Haemophilus influenzae type b. They were seen with signs and symptoms indistinguishable from infection caused by other organisms. One child was initially misdiagnosed as having septic arthritis because of failure to appreciate that Hemophilus may also cause bone infection. In the second patient osteomyelitis and arthritis developed during ampicillin sodium therapy for treatment of Hemophilus meningitis. His initial infection was caused by an ampicillin-sensitive isolate but his orthopedic infection subsequently responded to therapy only after changing to a regimen of chloramphenicol. In the third patient, bone scintigraphy was helpful in diagnosis since serial roentgenograms were not diagnostic of osteomyelitis. The anticapsular antibody responses of these patients were measured by radioimmune assay. The levels found were low but comparable to age-matched control children with H influenzae type b meningitis.

Antibodies, Bacterial↗

PubMed1979

Group B streptococcal osteomyelitis and septic arthritis. Its occurrence in infants less than 2 months old.

Nine infants less than 2 months of age with group B streptococcal (GBS) osteomyelitis or septic arthritis, or both, were seen from January 1975 through January 1978. The infants had local joint signs, usually in the absence of systemic signs. The bones and joints involved were equally distributed between proximal humerus and proximal and distal femur. An infant had involvement of the talus. Treatment consisted of two to three weeks of parenteral antibiotics, arthrotomy in infants with arthritis, and bone decompression in infants with osteomyelitis. Clinical follow-up showed normal growth and function of the affected joint. Of the organisms, five were typed: four were type III and one was type Ib. Group B streptococcal osteomyelitis and/or septic arthritis was the second most common late-onset GSB infection, being surpassed only by meningitis.

Arthritis, Infectious↗