Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Allison DC, Miller T, Holtom P, Patzakis MJ, Zalavras CG. Microbiology of upper extremity soft tissue abscesses in injecting drug abusers. Clin Orthop Relat Res. 2007;461:9–13. - PubMed
    1. Ang-Fonte GZ, Rozboril MB, Thompson GR. Changes in nongonococcal septic arthritis: drug abuse and methicillin-resistant Staphylococcus aureus. Arthritis Rheum. 1985;28:210–213. doi: 10.1002/art.1780280217. - DOI - PubMed
    1. Atkinson SR, Paul J, Sloan E, Curtis S, Miller R. The emergence of meticillin-resistant Staphylococcus aureus among injecting drug users. J Infect. 2009;58:339–345. doi: 10.1016/j.jinf.2009.03.004. - DOI - PubMed
    1. Belzunegui J, Rodriguez-Arrondo F, Gonzalez C, Queiro R, Martinez de Bujo M, Intxausti JJ, 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. - PubMed
    1. Brancos MA, Peris P, Miro JM, Monegal A, Gatell JM, Mallolas J, Mensa J, Garcia S, Munoz-Gomez J. Septic arthritis in heroin addicts. Semin Arthritis Rheum. 1991;21:81–87. doi: 10.1016/0049-0172(91)90041-W. - DOI - PubMed

MeSH terms