title: Is vancomycine still a choice for chronic osteomyelitis empirical therapy in iran?
abstract: BACKGROUND
  Pyogenic bacteria and especially Staphylococcus aurous (S. aurous) are the most common cause of chronic osteomyelitis. Not only treatment protocol of chronic osteomyelitis occasionally is amiss but also this malady responds to treatment difficultly.
  
  
  OBJECTIVE
  This study investigates antibiotic resistance pattern of S. aurous isolated from Iranian patients who suffer from chronic osteomyelitis by two methods: disk diffusion (Kirby bauyer) and E-test (Epsilometer test) to find Vancomycin susceptibility and MIC (Minimum inhibitory concentration).
  
  
  METHODS
  One hundred and thirty one patients who suffer from chronic osteomyelitis which have been referred to both governmental and private hospitals at 2010 were tried out for culturing of osteomyelitis site (sites). Antibiotic susceptibility and MIC of isolated bacteria were investigated by Kirby bauyer and E-test respectively.
  
  
  RESULTS
  Samples were collected from bone (73.4%), surrounding tissue (14.6%) and wound discharge (12%). S. aureus was isolated from 49.6% of the samples. According to disc diffusion, methicillin resistance S. aureus (MRSA) was 75% and Vancomycin resistance S. aurous (VRSA) was 0% and based on MIC, MRSA was 68.5% and VRSA was 0%. According to MIC experiments, maximum sensitivity was against to Vancomycin (90.2%) and ciprofloxacin (54.4%) respectively but based on disc diffusion, maximum sensitivity was against to Vancomycin (97.7%) and ciprofloxacin (43.2%), respectively (P = 0.001). E-test (9.8%) in comparison with Disc diffusion (2.3%) showed higher percent of intermediate susceptibility to Vancomycin (P = 0.017).
  
  
  CONCLUSIONS
  Comparison of antibiograms and MICs showed that Kirby bauyer technique especially for detection of VISA strains is not reliable comparison with E-test. Already VRSA strains have not detected in Iranian chronic osteomyelitis, Thus Vancomycin is the first choice for chronic osteomyelitis empirical therapy in Iran yet.
authors.affiliation: Health Research Center (HRC), Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
authors.forename: Morteza
authors.initials: M
authors.lastname: Izadi
authors.forename: Mohammad Mahdi
authors.initials: MM
authors.lastname: Zamani
authors.forename: Seyed Ahmad
authors.initials: SA
authors.lastname: Mousavi
authors.forename: Seyed Mir Mostafa
authors.initials: SM
authors.lastname: Sadat
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Siami
authors.forename: Noushin
authors.initials: N
authors.lastname: Vais Ahmadi
authors.forename: Nematollah
authors.initials: N
authors.lastname: Jonaidi Jafari
authors.forename: Shahram
authors.initials: S
authors.lastname: Shirvani
authors.forename: Mojgan
authors.initials: M
authors.lastname: Majidi Fard
authors.forename: Abbas Ali
authors.initials: AA
authors.lastname: Imani Fooladi
keywords: Iran; Methicillin-Resistant; Osteomyelitis; Staphylococcus Aurous; Vancomycin Resistance