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The Bone & Joint Journal
Vol. 99-B, Issue 11 | Pages 1545 - 1551
1 Nov 2017
Makki D Elgamal T Evans P Harvey D Jackson G Platt S

Aims

The aim of this paper was to present the clinical features of patients with musculoskeletal sources of methicillin-sensitive Staphylococcus aureus (MSSA) septicaemia.

Patients and Methods

A total of 137 patients presented with MSSA septicaemia between 2012 and 2015. The primary source of infection was musculoskeletal in 48 patients (35%). Musculoskeletal infection was considered the primary source of septicaemia when endocarditis and other obvious sources were excluded. All patients with an arthroplasty at the time were evaluated for any prosthetic involvement.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_13 | Pages 11 - 11
1 Jun 2016
Howard N Fazakerley SB Widnall J Harvey D Platt S Jackson G
Full Access

We aim to demonstrate the value of deep tissue biopsies to guide antimicrobial treatment of diabetic ulcers. Some recent studies have advocated the role of superficial swabs to guide antibiotic treatment in comparison to deep tissue biopsies previously perceived as the gold standard of microbiology diagnosis. We performed a retrospective analysis of microbiology culture results of patients with infected diabetic ulcers comparing superficial versus deep biopsy microbiology results.

Forty-one diabetic ulcers in 41 patients were included. The mean numbers of isolates from soft tissue and bone biopsies were 2.1 and 1.8 respectively. 39/41 combined soft tissue and bone biopsies were culture positive. The most prevalent organism seen in deep samples was Staphylococcus aureus (14) followed by anaerobes (9), and enterococcus (9). In superficial swab cultures 21 patients (51%) cultured non-specific, mixed skin flora and enteric species. The remaining 20 patients cultured Staphylococcus aureus (11), Streptococcus (6), Pseudomonas (2) and anaerobes (6).

Three superficial swabs matched deep tissue biopsy cultures. 16 deep biopsies grew organisms seen none specifically in superficial swab cultures with 22 deep tissue biopsies cultures growing organisms not seen on superficial swab with 8 being anaerobes.

We have shown that in 54% of cases, deep tissue cultures isolated organisms that were not grown by superficial swab cultures. We highlight the importance of deep tissue biopsies to guide effective treatment.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 112 - 112
1 Jan 2013
Gerrand C Beckingsale T Jackson G Murray S
Full Access

Aims

Solitary plasmacytoma of bone is a locally aggressive lesion seen by sarcoma teams. Some patients progress to myeloma. Local therapy decisions can be complex. This study reviews the experience of this condition in a single centre with a view to informing future treatment.

Methods

This was a retrospective review of clinical records.