International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 05 Issue 20, October, 2013

Pages: 52-58

Date of Publication: 02-Nov-2013

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Author: G. Suguneswari, A. Heraman Singh, Ranjan Basu

Category: Healthcare

Abstract:Objectives: Osteomyelitis has been continuing as the most important cause of morbidity among patients with bone infections. Even though early detection of cases and advanced treatments are in process, osteomyelitis is still continued as a major problem due to treatment failures and multidrug resistance. This study was conducted to determine the bacteriological profile of osteomyelitis and their susceptibility pattern to various antimicrobial drugs. The information would guide clinicians in treating osteomyelitis at the initial level so that chronic osteomyelitis can be prevented. Materials and Methods: A total of 100 clinically diagnosed cases of osteomyelitis were included in the study. Clinical specimens like pus, pus swabs, sequestrum of bone and synovial fluid were taken and cultured aerobically. The organisms isolated were identified by routine standard operative procedures. Antimicrobial susceptibility testing was done by Modified Kirby-Bauer's disc diffusion method and the results were interpreted following CLSI guidelines. Methicillin resistance was screened by using Oxacillin disks (1 mcg). Statistical analysis used: Data obtained was presented in counts and percentages and analysed with Fisher's Exact Probability test as applicable. Results: The predominant organisms isolated were Staphylococcus aureus (53.48%) followed by Staphylococcus epidermidis (13.95%), Pseudomonas areuginosa (10.46%), Proteus mirabilis (9.30%), Acinetobacter anitratus (6.97%), Klebsiella pneumoniae (5.82%). Cultures were sterile in 14 % of the cases. Among the isolates of Staphylococcus aureus, 30.33%. were methicillin resistant (MRSA). Most of the Gram positive bacteria were susceptible to Vancomycin, Levofloxacin, Piperacillin/ Tazobactam and Imipenem whereas Gram negative bacteria were susceptible to Piperacillin / Tazobactam, Imipenem, Levofloxacin, Amikacin and Tobramycin. All Methicillin resistant staphylococcus aureus (MRSA) strains were sensitive to Vancomycin. Conclusion: Emerging multidrug resistant strains is a major concern to treat Osteomyelitis. Appropriate selection of antibiotic would help to treat the disease successfully and limit the emergence of drug resistant strains to prevent morbidity and mortality.

Keywords: Osteomyelitis, MRSA, Antimicrobial susceptibility, Multi drug resistance.

Full Text:


Osteomyelitis is a bone infection which occurs due to the extension from an infected joint or by direct invasion as a result of trauma or instrumentation (1). Introduction of microorganisms into the bone may occur during stabilization of the fracture, implanting prosthesis or due to trauma. Prosthetic implants create an environment which favors microbial colonization and establishment of infection successfully in the bone (2). The infective agents adhere to foreign material in the body and secrete glycocalyx that inhibits the host defense mechanism and action of antibiotics so that infection can be established which would be difficult to eradicate (3).

The incidence of osteomyelitis has been lowered to a certain extent due to the rapid diagnosis and the availability of multiple antibiotics along with modern treatment facilities(4); but still, osteomyelitis is an ongoing problem due to emergence of multi drug resistant strains among bacterial pathogens like Staphylococcus aureus and Pseudomonas areuginosa .Inappropriate and excessive use of antibiotics is considered as the main cause of development of drug resistance. Diagnosing the etiological agent and appropriate use of antibiotics are crucial in the treatment of infection preventing further complications (5). The present study was conducted to study the bacteriological profile of osteomyelitis along with the antimicrobial susceptibility patterns so as to establish empiric therapy guidelines at the hospital set up.


A total of 100 clinically diagnosed cases of osteomyelitis attending the Orthopedic OPD and IPD of Andhra Medical College, a teaching and tertiary care government hospital at Visakhapatnam, during the period between Nov 2002 and Nov 2005 were included in this study. The important factors taken into consideration were the patient's age, sex, occupation, bone involved, signs, symptoms, duration of the illness and predisposing risk factors.  Specimens like pus, pus swabs, sequestrum of bone, synovial fluid were collected under aseptic precautions. The samples were processed aerobically using routine standard operative procedures. The culture isolates were identified by Gram stain morphology, colony characters and biochemical reactions(6,7) . The isolates were then subjected to antimicrobial susceptibility testing by Modified Kirby-Bauer disc diffusion method and the results were interpreted as per CLSI guidelines (8). Antibiotics  tested were  Penicillin G (10 IU ), Ampicillin (10 ug),  Pipercillin (30ug), Pipercillin / Tazobactum    (100/10 ug), Oxacillin (1ug), Vancomycin (30ug) , clindamycin  (2 mcg), levofloxacin (5 ug),  Ciprofloxacin (5ug), Erythromycin (5ug), Amikacin (30ug), Gentamycin (30 ug), tobramycin (10 ug), Co-trimoxazole (1.25/23.75 ug), Tetracycline (30 ug), ceftazidime (30 ug), cefotaxime (30 ug), ceftriaxone ( 30 ug), cefepime (30 ug), aztreonam (30 ug), imipenem (10 ug). Screenings of methicillin resistant strains was done by using Oxacillin (1ug) discs. ( HI MEDIA , MUMBAI )

Data obtained in the study is presented with counts and percentages and Fisher’s Exact Probability test was used to calculate p value.


 Male preponderance was observed in this study and accounted for 87.5%. The age group which involved majorly with osteomyelitis was between 30-40 years      ( 29 % ) followed by 20-30 years   ( 23 % ) , 10-20 ( 17 % ) , 40-50 ( 15 % ) , 1-10 ( 8 % ) and 50 and above (7%). The major predisposing factor identified was accidents  (53 %) , followed by post surgical wounds   (26 % ) , and prosthesis and others (20 %) as shown in Table –1 and observed to be statistically significant [P value – 0.0134    ( < 0.05 ) ].

The commonest bone affected in this study was tibia with 58%, followed by femur, 31%, humerus, 3% , ulna, calcaneum, and phalanx of each 2% and radius, front temporal bones of 1% each respectively ( Table – 2 ).

Socioeconomic status of the cases was analyzed and almost 63% cases affected were from the lower income group and 37 % were from the middle income group; no involvement of higher income group with osteomyelitis was observed in this study. This could explain how the lower socioeconomic group has a relation between the occupation and the disease.

Among the hundred cases studied, culture positivity was obtained in 86 cases (86 % ). The dominant organism obtained in the present study was Staphylococcus aureus (53.48 %), and the rest of the isolates were Staphylococcus epidermidis (13.95%), Pseudomonas areuginosa (10.46 %), Proteus mirabilis (9.30 %), Acinetobacter anitratus (6.97%), Klebsiella pneumonia (5.82%)    (Table –3). Among Staphylococcus species, 23.92 % were MRSA and 76.08 % were MSSA    (Table – 4).

Antibiotic susceptibility patterns of Staphylococcus species, MRSA, Gram negative bacilli / fermenter and Gram negative bacilli / non-fermenter have been presented in Table – 5 ,Table – 6, Table – 7  and  Table – 8, respectively .   


Osteomyelitis is one of the most inconvenient diseases among most of the developing countries like India. An increase in the emergence of drug resistant strains makes treatment even more complicated. Hence, area-wise studies on bacteriological profiles and their antimicrobial susceptibility pattern are essential to guide policy on the appropriate use of antibiotics.  

The incidence of osteomyelitis was observed high among males and in age groups between 20-40 years which states that the younger age groups are more accident prone in relation to their occupation. Accidents were observed to be the most common predisposing factor in this study and leads to epiphysial cell destruction and hemorrhage which in turn decreases tissue resistance (4). Postoperative wounds and prosthesis were the other risk factors observed in this study. In relation to age wise distribution, our study collaborates with the studies by Muggeridge E. Et al and differs with the study by Waldvogel F. et al which were reported maximum and minimum incidence respectively (9, 10 ).

The common bones involved in this study were lower extremities which are similar to the studies by Kaur J. et al (4) and Muggeridge E. et al (9).

Staphylococcus was the major isolate in this study which coincides with different studies by Rao PS. et al (11), Along TO. et al. (12), Fernandez al (13) and Muggeridge E. et al (9) but differed by the study with Kaur, J et al (4) who observed a lower  incidence in children .

Even though the gram negative organisms are increasing rapidly since longer time, still staphylococcus remained the most common isolate of osteomyelitis. On the other hand, methicillin resistant strains are aggravating the disease further. All the MRSA strains were resistant to beta-lactum drugs and multiple antibiotics. The high resistance of MRSA was observed for Ciprofloxacin and Gentamicin which correlates with studies by Kaur, J et al (4) . All the MRSA strains showed 100% sensitivity to Vancomycin and 91.66 % sensitivity to Levofloxacin which correlates with the study by Kaur, J et al (4).

Our study revealed that overall Piperacillin / Tazobactum combination was the most sensitive drug among all the Gram negative bacilli followed by Imipenem, Levofloxacin, Amikacin and Aztreonam. Among the Enterobacteriaceae, Imipenem was more sensitive whereas among Non – fermenters Aztreonam and Levofloxacin were the most active drugs. 

Most of the Enterobacteriaceae and GNB, Non-fermenters showed resistance against 3rd generation cephalosporins like Cephotaxim, Ceftazidime, Ceftriaxone etc.  

The MRSA isolates showed extensive resistance to most of the commonly used antibiotics like Cefepime (100%), Erythromycin (90.9%), Tetracycline (90.9%), Co-trimoxazole (90.9%), Piperacillin / Tazobactum (81.82%), Ciprofloxacin (72.73%), and Levofloxacin ( 54.55%) . 


Osteomyelitis has been the major cause of morbidity since long. Emerging multidrug resistant strains is of major concern to treat the disease. Even though gram negative bacteria are being increased significantly but still Staphylococcus aureus is being continued as a major etiological agent of osteomyelitis. Betalactamase production and methicillin resistance pose challenge in the treatment of osteomyelitis. Appropriate and judicious selection of antibiotic by using antibiotic sensitivity data would limit the emerging drug resistant strains in the future to treat the disease successfully. Our study thereby will guide the clinician in choosing appropriate antibiotics which not only contribute to better treatment but there judicious use will also help in preventing emergence of resistance to the drug which are still sensitive .


The authors would like to thank Dr. Y. Narayana Rao, Principal, Andhra Medical College, Visakhapatnam, Dr. M. Subhadra Devi, Professor and Head of the Department of Microbiology and Dr. Ambedkar, Professor and Head of the Department of Orthopedics for their constant encouragement and kind help throughout the period of work.


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  3. Topley and Wilson’s Principles of bacteriology, virology and immunity; Systemic bacteriology, vol2, ed-9 ; Edward Arnold, 1998 ; p-557-632,1035-1050,1091-1109 .
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Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to for more details.

Best Article Award

A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Leow Jun Xian and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. entitled "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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List of Awardees

A Study by Ese Anibor et al. entitled "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award

A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

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