Microbiology of Bone and Joint Infections in Injecting Drug Abusers
- First Online:
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.
We therefore determined the spectrum of organisms in bone and joint infections in patients who were injecting drug users.
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%).
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.
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.
- 4.Belzunegui J, Rodriguez-Arrondo F, Gonzalez C, Queiro R, Martinez de Bujo M, Intxausti JJ, De Dios JR, Figueroa M. Musculoskeletal infections in intravenous drug addicts: report of 34 cases with analysis of microbiological aspects and pathogenic mechanisms. Clin Exp Rheumatol. 2000;18:383–386.PubMedGoogle Scholar
- 15.Munoz-Fernandez S, Macia MA, Pantoja L, Cardenal A, Pena JM, Martin Mola E, Balsa A, Barbado FJ, Vazquez JJ, Gijon Banos J. Osteoarticular infection in intravenous drug abusers: influence of HIV infection and differences with non drug abusers. Ann Rheum Dis. 1993;52:570–574.CrossRefPubMedGoogle Scholar
- 17.Office of National Drug Control Policy Web site. National Household Survey on Drug Abuse 2001. Available at: http://www.whitehousedrugpolicy.gov/drugfact/nhsda01.html. Accessed August 10, 2009.
- 21.Summanen PH, Talan DA, Strong C, McTeague M, Bennion R, Thompson JE, Jr., Vaisanen ML, Moran G, Winer M, Finegold SM. Bacteriology of skin and soft-tissue infections: comparison of infections in intravenous drug users and individuals with no history of intravenous drug use. Clin Infect Dis. 1995;20 Suppl 2:S279–S282.PubMedGoogle Scholar
- 22.United Nations Office on Drugs and Crime Web site. World Drug Report 2009. Available at: http://viewer.zmags.com/publication/a8a299fc#/a8a299fc/1. Accessed August 10, 2009.
- 23.US Department of Health and Human Services Web site. National Survey on Drug Use and Health 2007. Available at: http://dx.doi.org/10.3886/ICPSR23782. Accessed August 10, 2009.