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Background <p>Osteoarticular and soft tissue (OA/ST) infections can be culture-negative in over 40% of cases due to factors such as insufficient antibiotic-free periods (AFP) and improper sampling techniques. This prospective study aimed to evaluate the efficacy of a newly developed, structured protocol for sampling in clinically evident OA/ST infections.</p> Methods <p>The study included all cases of clinico-radiologically evident OA/ST infections. A standard operating protocol (SOP) for sampling was developed by a multidisciplinary team. Intra-operative samples were analyzed through staining, Gene Xpert, aerobic and anaerobic bacterial cultures, mycobacterial, and fungal cultures, and histopathological analysis. Infected fluid samples were inoculated in blood culture bottles (BCB). Culture yield, time to yield, AFP’s impact, pathogen isolation, and antimicrobial resistance (AMR) were studied.</p> Results <p>A total of 212 OA/ST infection cases were prospectively enrolled in the study. Out of 212 patients, 189 (89.2%) showed positive cultures. BCB positivity (81.5%) was significantly better than tissue positivity (71.6%) (<i>p</i> &lt; 0.05). Overall, combined positivity (89.2%) was significantly better than either alone (<i>p</i> &lt; 0.05). Polymicrobial infections accounted for 29.7% of cases. Gram-negative organisms (47.5%) were more prevalent than Gram-positive organisms (39.7%). 15 fungi and 19 cases of mycobacteria infection were isolated. ESKAPE organisms comprised 50.9% of isolates.</p> Conclusion <p>The multidisciplinary SOP significantly improved culture positivity in OA/ST infections. The study highlights the microbiota and AMR patterns at a tertiary care hospital in India, emphasizing the need for vigilant policy interventions to address emerging drug-resistant infections. Identifying pathogens and initiating appropriate therapy are crucial for reducing clinical and economic burdens.</p>

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Protocol-Based Sampling in Osteoarticular and Soft Tissue Infections: Enhanced Culture Yield and Microbiota Identification Unmasks Despairing Microbiological Flora and Antimicrobial Resistance

  • 期刊论文

  • 发表日期：

    2026年5月5日

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  • Aditya Menon,
  • Rishabh Tripathi,
  • Madhav Chowdhry,
  • Camilla Rodrigues,
  • Anjali Shetty,
  • Ayesha Sunavala,
  • Umang Agrawal,
  • Shaoli Basu,
  • Vikas M. Agashe

摘要

Background

Osteoarticular and soft tissue (OA/ST) infections can be culture-negative in over 40% of cases due to factors such as insufficient antibiotic-free periods (AFP) and improper sampling techniques. This prospective study aimed to evaluate the efficacy of a newly developed, structured protocol for sampling in clinically evident OA/ST infections.

Methods

The study included all cases of clinico-radiologically evident OA/ST infections. A standard operating protocol (SOP) for sampling was developed by a multidisciplinary team. Intra-operative samples were analyzed through staining, Gene Xpert, aerobic and anaerobic bacterial cultures, mycobacterial, and fungal cultures, and histopathological analysis. Infected fluid samples were inoculated in blood culture bottles (BCB). Culture yield, time to yield, AFP’s impact, pathogen isolation, and antimicrobial resistance (AMR) were studied.

Results

A total of 212 OA/ST infection cases were prospectively enrolled in the study. Out of 212 patients, 189 (89.2%) showed positive cultures. BCB positivity (81.5%) was significantly better than tissue positivity (71.6%) (p < 0.05). Overall, combined positivity (89.2%) was significantly better than either alone (p < 0.05). Polymicrobial infections accounted for 29.7% of cases. Gram-negative organisms (47.5%) were more prevalent than Gram-positive organisms (39.7%). 15 fungi and 19 cases of mycobacteria infection were isolated. ESKAPE organisms comprised 50.9% of isolates.

Conclusion

The multidisciplinary SOP significantly improved culture positivity in OA/ST infections. The study highlights the microbiota and AMR patterns at a tertiary care hospital in India, emphasizing the need for vigilant policy interventions to address emerging drug-resistant infections. Identifying pathogens and initiating appropriate therapy are crucial for reducing clinical and economic burdens.