Take a look at the following

Eur J Clin Microbiol Infect Dis. 2006 Aug;25(8):522-6.

Changing trends in etiology of bacteremia in patients with cancer.

Safdar A1, Rodriguez GH, Balakrishnan M, Tarrand JJ, Rolston KV.

Author information

1Department of Infectious Diseases, Infection Control, and Employee Health, Unit 402, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. [email protected]

Abstract

The present study was conducted to determine trends in the quantitative bacterial load patterns of bacterial bloodstream infections (BSI) caused by various bacteria in patients receiving care at a comprehensive cancer center. Bacterial loads of all consecutive quantitative blood cultures performed during 1998 and 2004 were graded quantitatively. Gram-positive bacteria (GPB) were responsible for the majority of BSI episodes in both years studied: 740 of 1,055 (73%) in 1998 and 820 of 1,025 (82%) in 2004. Compared with GPB infections, a significant proportion of infections caused by Gram-negative bacteria was associated with a high bacterial load (HBL) (11 vs 28% in 1998 and 10 vs 30% in 2004; p

Thanks a lot for the information is very interesting and useful, in this case the infections are being in young previously healthy  trauma patients treated with orthopaedic implants so it must be a very aggressive strain.

You are very welcome

Not so uncommon, please take a look at the following:

A rabbit osteomyelitis model to simulate multibacterial war wound infections.Mil Med. 2013 Jun;178(6):696-700.

Yin LY1, Manring MM, Calhoun JH.

Abstract

A challenge facing military caregivers is the presence of multidrug-resistant infection in extremity wounds. Most frequently identified resistant strains are methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae (KP), Pseudomonas aeruginosa (PA), and Acinetobacter baumannii (AB). We adapted an existing osteomyelitis model to simulate an infected extremity wound for antibiotic testing. New Zealand White Rabbits (n = 95) were divided into 6 inoculation groups for infection with MRSA, KP, PA, and AB alone, and in multibacteria infections. Sodium morrhuate was injected into the left tibia to simulate blast wound trauma, then the respective bacteria or combination of pathogens, and finally sterile saline were injected. Colony-forming units for the mono-organism groups showed that AB, KP, or PA alone at 10(7) colony-forming units per mL (CFUs/mL) was effective for rabbit osteomyelitis induction. Colony-forming units for the multiorganism groups showed that the combination of AB (10(7) CFUs/mL)/KP (10(7) CFUs/mL)/PA (10(7) CFUs/mL)/MRSA (10(5) CFUs/mL) yielded a 100% osteomyelitis induction rate. At 8 weeks, however, only one mono-bacterial group and one multibacterial group showed significant radiographic improvement (p < 0.05). The rabbit model of osteomyelitis can be adapted to study infected blast wounds typical of those seen in veterans. To our knowledge, this is the first demonstration of the model simulating multibacterial infections with multidrug-resistant organisms.

Multidrug-resistant Acinetobacter baumannii infection following para-articular steroid injection in the knee--a case report.Bull NYU Hosp Jt Dis. 2012;70(4):276-8.

Artiaco S1, Cicero G, Bellomo F, Bianchi P.

Abstract

Acinetobacter baumannii is an emerging gram-negative nosocomial pathogen that rarely causes infections in orthopaedic patients. We report a case of imipenem-resistant Acinetobacter baumannii paraarticular infection of the knee occurring in a healthy patient following one ambulatory steroid injection for the treatment of quadriceps tendinopathy. The infection was reduced by early surgical debridement of infected tissues, abscess drainage, and prolonged antibiotic therapy with colistin. To our knowledge, this is the first case in the literature reporting such an infection following single steroid injection in orthopaedic patients.

Epidemiology and antimicrobial sensitivities of 536 multi-drug-resistant gram-negative bacilli isolated from patients treated on surgical wards.Surg Infect (Larchmt). 2012 Oct;13(5):326-31.

Maraki S1, Mavros MN, Kofteridis DP, Samonis G, Falagas ME.

Abstract

BACKGROUND:

In this era of increasing antimicrobial resistance, infections caused by multi-drug-resistant (MDR) gram-negative bacilli (GNB) are becoming more common and pose a challenge to all clinicians, including surgeons.

METHODS:

We evaluated the epidemiology and antimicrobial sensitivities of GNB isolated from patients treated on surgical wards at the University Hospital of Heraklion, Crete, Greece, from 2004 to 2009. The MDR isolates were defined according to an international expert proposal supported by the U.S. Centers for Disease Control and Prevention and the European Centre for Disease Prevention and Control.

RESULTS:

A total of 1,153 GNB were isolated; 536 (46.5%) were MDR. The most common isolates were Escherichia coli (312 [27.8%]; MDR rate 50.2%), Pseudomonas aeruginosa (298 [25.8%]; MDR rate 39.6%), Acinetobacter baumannii (137 [11.9%]; MDR rate 83.9%), and Klebsiella pneumoniae (112 [9.7%]; MDR rate 44.6%). Most pathogens were isolated from patients hospitalized in the Departments of Surgical Oncology (32.3%), Orthopedic and Trauma Surgery (31.8%), General Surgery (18.1%), and Pediatric Surgery (15.5%). The clinical specimens comprised pus (45.1%), normally sterile fluids (22.5%), urine (16.8%), blood (6.3%), and other body fluids. Most effective in vitro against all MDR pathogens were colistin (83%), meropenem (57%), and imipenem-cilastatin (56%). The MDR P. aeruginosa was susceptible most often to colistin (94%) and aminoglycosides (tobramycin 56%, amikacin 55%), MDR A. baumannii only to colistin (94%), and MDR K. pneumoniae to meropenem (92%) and aminoglycosides (amikacin 76%, gentamicin 74%).

CONCLUSION:

In a region with a high prevalence of antibiotic resistance, almost one-half of GNB isolated from surgical patients were MDR. Surgeons may consider these developments to guide empiric antibiotic therapy for infections caused by gram-negative pathogens.

Gram-negative osteomyelitis: clinical and microbiological profile.Braz J Infect Dis. 2012 Jan-Feb;16(1):63-7.

 Carvalho VC1, Oliveira PR, Dal-Paz K, Paula AP, Félix Cda S, Lima AL.

Abstract

INTRODUCTION:

Despite the growing interest in the study of Gram-negative bacilli (GNB) infections, very little information on osteomyelitis caused by GNB is available in the medical literature.

OBJECTIVES AND METHODS:

To assess clinical and microbiological features of 101 cases of osteomyelitis caused by GNB alone, between January 2007 and January 2009, in a reference center for the treatment of high complexity traumas in the city of São Paulo.

RESULTS:

Most patients were men (63%), with median age of 42 years, affected by chronic osteomyelitis (43%) or acute osteomyelitis associated to open fractures (32%), the majority on the lower limbs (71%). The patients were treated with antibiotics as inpatients for 40 days (median) and for 99 days (median) in outpatient settings. After 6 months follow-up, the clinical remission rate was around 60%, relapse 19%, amputation 7%, and death 5%. Nine percent of cases were lost to follow-up. A total of 121 GNB was isolated from 101 clinical samples. The most frequently isolated pathogens were Enterobacter sp. (25%), Acinetobacter baumannii (21%) e Pseudomonas aeruginosa (20%). Susceptibility to carbapenems was about 100% for Enterobacter sp., 75% for Pseudomonas aeruginosa and 60% for Acinetobacter baumannii.

CONCLUSION:

Osteomyelitis caused by GNB remains a serious therapeutic challenge, especially when associated to nonfermenting bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.

Combat-related L3 fracture treated with L2-L4 posterior spinal fusion complicated by multidrug-resistant acinetobacter infection.Spine J. 2012 Sep;12(9):864-6.

Dworak TC1, Kang DG, Lehman RA Jr.

Multidrug-resistant chronic osteomyelitis complicating war injury in Iraqi civilians.J Trauma. 2011 Jul;71(1):252-4.

Murphy RA1, Ronat JB, Fakhri RM, Herard P, Blackwell N, Abgrall S, Anderson DJ.

Abstract

BACKGROUND:

War-related orthopedic injury is frequently complicated by environmental contamination and delays in management, placing victims at increased risk for long-term infectious complications. We describe, among Iraqi civilians with war-related chronic osteomyelitis, the bacteriology of infection at the time of admission.

METHODS:

In the Médecins Sans Frontières Reconstructive Surgery Project in Amman, Jordan, we retrospectively reviewed baseline demographics and results of initial intraoperative surgical cultures among Iraqi civilians with suspected osteomyelitis.

RESULTS:

One hundred thirty-seven patients (90% male; median age, 35 years [interquartile range {IQR}, 28-46]; median time since initial injury, 19 months [IQR, 10-35]) were admitted with suspected chronic osteomyelitis after war-related injury. One hundred seven patients had a positive intraoperative culture. Before arrival, patients had undergone a median of 4 (IQR, 2-6) surgical procedures in Iraq. Fifty-nine (55%) of 107 patients with confirmed osteomyelitis had a multidrug-resistant (MDR) organism isolated at admission: cefepime-resistant Enterobacteriaceae (n = 40), methicillin-resistant Staphylococcus aureus (n = 16), and MDR Acinetobacter baumannii (n = 3). An association of borderline significance existed between a history of more than two prior surgical procedures in Iraq and an MDR isolate at program entry (multivariate: odds ratio, 5.3; 95% confidence interval, 0.9-30.6; p = 0.064).

CONCLUSION:

Health care actors, including Iraqi health facilities and humanitarian medical organizations, must be aware of the link between chronic war injury and antimicrobial drug resistance in this region and should be prepared for the management challenges involved with the treatment of chronic drug-resistant osteomyelitis.

Hi Marco,

 As presented by Amar, there is a substantial concern about A. baumannii complex infection in hospitals in particular for severely ill patients in care units. 

Have a look at the attached presentation I think it provides a comprehensive epidemiology, ICP, treatment, etc....  I hope you find it helpful.

Hi,

 I have completed my PhDs student's thesis on Genotyping and antibiotic resistance pattern of A.baumanii from Ventilator Associated Pneumonia cases.  We have  done another study on biofilm production  among A.baumanii,  we have a stock of all A.b isolates from clinical samples. If you are interested we can  do further studies.

 Yes, I am interested in HIV related funded projects on drug efficacy, vaccine  and HIV , role of vaccine in reducing the viral load, vaccine and opportunistic infections, combination  vaccine and drug therapy to prevent possible viral mutation,  vaccine on Indian population. Any project of your choice. 

For me  who has been involved actively since 1996 in NACO related HIV activities including state referral centre, I am interested to take up such project works, but the biggest hindrance was always funding.

i will offer all the necessary help both actively and in paper work.

y

 Sorry for the late response, is really a surprise to me the not so uncommon presentation of this infrctoon, thanks a lot for the information and I'll look forward for the opportunity to work together.