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February 1988, Volume 38, Issue 2

Original Article


Umar Farooq  ( Postgraduate Medical Institute, Lahore. )
Iftikhar Farooq Ahmad  ( Pakistan Medical Research Council Research Centre, Punjab Medical College, Faisalabad. )


Investigations were carried out to study the organisms associated with 80 cases of osteomyelitis at Faisalabad. Seventy eight had infection with single organism; whereas there was no growth in 2 cases. On culture, the frequency of the organisms was Staphylococcus aureus in 30 (37.5%), Streptococcus pyogenes in 28 (35%); Escherichia co/i in 16 (20%); Salmonella in 3 (32%) and Proteus vulgar/s in 1(1.3%) case. (JPMA 38: 43, 1988).


Osteomyelitis is a common orthopedic problem because bones are prone to infection through traumatic1, iatrogenic and hematogenic routes. 2 Various organisms are associated with the infection, of which Staphylococcus aureus is the commonest and is followed by Streptococcus pyogenes, E. Coli, Pseudomonas and Crypto­coccus. 3 Although the frequency of osteomyelitis is high in various hospitals of Faisalabad but the information about the infecting organisms is scarce. The present study is an attempt to find out the causative organism ofosteomyeitis under our circumstances.


The samples were collected from 80 patients with osteomyelitis of different bones through swabs, syringes and sequestrum from various hospitals of Faisalabad city, between January and July, 1983 (Table I).

Swabs were taken from ulcers caused by osteomyelitis from exposed bone surfaces and from the sinuses which were in direct contact with the site of lesions pouring generous discharge. Syringes were used for aspiration of exudate in the deep lying abscesses and from small abscesses present at the margins and floor of ulcers. The pieces of sequestrum obtained through sequesterectomy operation were used for inoculation.4,5
Isolates from Osteomyeitis Cases of Man.
Pus material from each case was examined by direct smear examination. The Burke’s modi­fication of Gram’s staining method was adopted. Each slide was examined, under oil immersion lenses for the shape and staining reaction of or­ganisms.6
Inoculation of Media:
The primary cultures were obtained by rubbing the swab, sequestrum or the aspirate on the surface of blood agar. The nutrient agar plates were used for maintaining the stock cultures of pure isolates. Subsequently the cultures were done, on the Sabourad’s dextrose agar, Mac­Conkey’s agar and Staphylococcus medium No 110 for identification and characteristic studies of specific organisms6.

Stained slides were examined under micros­cope using oil immersion lenses for studying the shape of the organisms, arrangement of the cells and staining reactions. The size of the cells was determined with the aid of stage and eye piece micrometer.6
Biochemical tests were performed, by standard methods used for identification and confirmation of the microorganisms isolated in each case6,7


Material examined from 80 human cases of osteomyelitis revealed infection with single organism in 78 cases whereas there was no growth in 2 cases. The cultures grown showed Staphylo­coccus aureus in 30 (37.5%), Streptococcus pyogenes in 28 (35%), Escherichia coil in 16 (20%), Salmonellae in 3 (3.7%), Proteus vuigaris in 1 case (13%) and no organisms were seen in 2 (2.5%) cases Table II.

I. Organisms identified from different Specimens:
Organisms isolated from various specimens such as swabs, syringes, sequestrum, were as follows:— Cultures from 60 swab specimens. Showed Staphylococcus aureus in 22, Streptococcus pyogenes in 21, Escherichia coil in 14, Salmonella in 1, Proteus vulgaris in 1 and no growth in 1 case. Cultures from 16 syringe specimens revealed Staphylococcus aureus in 7, Strepto­coccus pyogenes in 6, Escherichia coil in 1 and Salmonellae in 2 cases. Four sequestrum specimens revealed Staphylococcus aureus in 1, Streptococcus pyogenes in 1, Escherichia coil in 1; whereas no organism was observed in 1 case (Table III).

II. Organisms identified from various manifes­tations of Osteomyeitis:
The organisms identified from various manifestations of osteomyelltis have been tabulated (Table IV)

and their details are as follows: Four abscess samples showed Staphy­lococcus aureus in 2 and Streptococcus pyogenes in 2 cases. Samples from 13 sinus samples revealed Staphylococcus aureus in 6, Streptococcus pyo­genes in S , Escherichia coil in 2 cases. Fiftynine cases manifested by ulcers showed Staphylococcus aureus in 21, Strepto­coccus pyogenes in 20, Escherichia coil in 13, Salmonellae in 3, Proteus vuigaris in 1 whereas no growth was seen in 1 case. Four sequestrum samples revealed Stap­hylococcus aureus in 1, Streptococcus pyogenes in 1, Escherichia coli in 1 and no organisms in 1 case.


Pus samples were collected from 80 osteo­myelitis patients from various hospitals in and around Faisalabad. Bacterial growth was present in 78 (97.5%) cases while two samples did not show any bacterial growth. Single organisms were grown from each of the 78 cases. The cases of osteo­myelitis studied were chronic and had been under some kind of antibacterial treatments. This may explain the absence of any organism in some cases. Isolation of only one type of organisms indicate that either the choice of antibiotic was wrong or the organisms had become antibiotic resistant. Bacterial antagonism may have played some part in reducing the type of organisms in some cases. 8 Two cases did not show any growth. Aseptic osteomyelitis has also been reported by other workers9,10 Seventy eight isolates of different bacteria in this study comprised 30 isolates (37.5%) of Staphylococcus aureus, 28 (35.0%) of Strep­tococcus pyogenes, 6 (20.0%) of Escherichia coil, 3(3.7%) of Salmonellae and 1 isolate (1.3%) of Proteus wlgaris. Similar bacteria have been isolated from osteomyelitis patients by other workers11-17.  Osteomyelitis has also been due to other bacterial infections flamely Neisseria gonorrhoea18, Bacillus19, Serratia, Marcescens9,20 Enterobacter aerogenese21, Rhodococcus22, and Pseudomo­nas23, while other workers have isolated Hemop­hillus influen;ae, Haemophillus aphrophillus and Coccobadilli1,24. These organisms were not isolate4 from the patients in the present study. This may be due to lower incidence of these species in Faisalabad.


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