Microbiological diagnosis of intramedullary nailing infection: comparison of bacterial growth between tissue sampling and sonication fluid cultures
Microbiological diagnosis of intramedullary nailing infection: comparison of bacterial growth between tissue sampling and sonication fluid cultures
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DOI：
10.1007/s00264-020-04771-y
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发表时间：
2020-08-11
影响因子：
2.7
通讯作者：
Salles, Mauro Jose
中科院分区：
文献类型：
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作者：
Finelli, Carlos Augusto;da Silva, Cely Barreto;Salles, Mauro Jose
背景髓内钉（IMN）已被频繁用于治疗长骨开放性和闭合性骨折，但髓内钉感染（IMNI）可能会造成毁灭性的后果。超声一直被认为是在各种骨科植入物相关感染中微生物鉴定的重要附加手段，但其在IMNI中的作用研究甚少。我们的目的是评估常规种植体周围组织培养（TC）样品与IMNI的超声液体培养（SCs）获得的准确性。方法自2014年6月开始进行的纵向前瞻性队列研究，纳入因任何原因有IMN切除指征的患者。INMI的临床诊断是根据骨折相关感染的出版物定义的。从TC中培养最少两个样本。SCs遵循先前发布的协议。相关比例采用McNemar检验进行统计分析。结果我们纳入了54例接受IMN检索的患者，其中47例出现IMNI的临床症状。TC和SC检测微生物的灵敏度分别为89.4%（42/47）和97.6%(40/41)，特异性均为71.4% (5/7)（p= 1.00）。TC和SC的阳性预测值分别为95.5%（42/44）、95.2%（40/42）、50%（5/10）和83.3%（5/6）。在TC和SC中分离的最常见的生物是金黄色葡萄球菌，S。epidermidis andEnterococcussp。多微生物感染检出率分别为14.8%（8/54）和25% (12/48)（p =0.19）。结论超声液和组织标本对IMNI的诊断准确率相近，但SC在检测多微生物感染方面具有优势。
Background Intramedullary nailing (IMN) has been frequently indicated to treat long bone open and closed fractures, but IMN infection (IMNI) may have devastating consequences. Sonication has been regarded as an important add-on for microbial identification on a variety of orthopaedic implant-associated infections, but its role in the IMNI is poorly studied. We aim at evaluating the accuracy obtained by conventional peri-implant tissue culture (TC) samples with sonication fluid cultures (SCs) of IMNI. Methods Longitudinal prospective cohort study ongoing since June 2014, which included patients with indication for IMN removal due to any reason. Clinical diagnosis of INMI was defined according to publication addressing fracture-related infections. Minimal of two samples from TC were cultured. SCs followed the protocol previously published. Statistical analysis was performed using McNemar's test for related proportions. Results We included 54 patients submitted to IMN retrieval, of whom 47 presenting clinical signs of IMNI. Sensitivity for detecting microorganisms using TC and SC was 89.4% (42/47) and 97.6% (40/41), and specificity was 71.4% (5/7) for both TC and SC (p= 1.00). Positive and negative predictive values for TC and SC were 95.5% (42/44), 95.2% (40/42), 50% (5/10), and 83.3% (5/6), respectively. The most frequent organisms isolated in both TC and SC wereStaphylococcus aureus,S. epidermidis, andEnterococcussp. Polymicrobial infection was diagnosed in 14.8% (8/54) and 25% (12/48) by TC and SC, respectively (p =0.19). Conclusion Sonication fluid and tissue samples presented similar accuracy on the diagnosis of IMNI, but SC was advantageous of detecting polymicrobial infection.