Etiologic diagnosis of chronic osteomyelitis - A prospective study
Etiologic diagnosis of chronic osteomyelitis - A prospective study
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DOI：
10.1001/archinte.166.1.95
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发表时间：
2006-01-09
影响因子：
--
通讯作者：
Vesga, O
中科院分区：
文献类型：
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作者：
Zuluaga, AF;Galvis, W;Vesga, O
背景：虽然骨标本在 25 年前就被确立为慢性骨髓炎病因诊断的金标准，但最近的研究表明，非骨标本在识别病原体方面与骨标本一样准确。我们检查了 100 名患者的非骨和骨样本培养物之间的一致性率。方法：在圣维森特德保罗大学医院（位于哥伦比亚麦德林的一家拥有 750 个床位的大学医院）进行的前瞻性研究。我们纳入了至少 48 小时未接受抗生素治疗的慢性骨髓炎患者，不包括患有糖尿病足和褥疮的患者。从每个个体中至少采集 1 个非骨样本和 1 个骨样本，并进行完整的微生物学分析。结果：骨培养可以在 94% 的病例中鉴定出病原体，其中 14% 的病例中可以鉴定出厌氧菌。非骨和骨标本的培养在 30% 的患者中给出了相同的结果，其中由金黄色葡萄球菌 (42%) 引起的慢性骨髓炎的一致性略好于所有其他细菌物种 (22%) 引起的慢性骨髓炎。然而，由 Cohen kappa 统计确定的统计一致性小于 0 (-0.0092 +/- 0.0324)，表明观察到的一致性并不好于单独偶然预期的结果 (P >.99)。 结论：慢性骨髓炎的适当诊断和治疗需要对受感染骨进行微生物培养。非骨标本不适用于此目的。
Background: Although bone specimens were established 25 years ago as the gold standard for etiologic diagnosis of chronic osteomyelitis, recent studies suggest that nonbone specimens are as accurate as bone to identify the causative agent. We examined concordance rates between cultures from nonbone and bone specimens in 100 patients.Methods: Prospective study conducted at Hospital Universitario San Vicente de Paul, a 750-bed university-based hospital located in Medellin, Colombia. We included patients with chronic osteomyelitis who had been free of antibiotic therapy for at least 48 hours, excluding those with diabetic foot and decubitus ulcers. At least 1 nonbone and 1 bone specimen were taken from each individual and subjected to complete microbiologic analysis.Results: Bone cultures allowed agent identification in 94% of cases, including anaerobic bacteria in 14%. Cultures of nonbone and bone specimens gave identical results in 30% of patients, with slightly better concordance in chronic osteomyelitis caused by Staphylococcus aureus (42%) than by all other bacterial species (22%). However, statistical concordance determined by the Cohen kappa statistic was less than 0 (-0.0092 +/- 0.0324), indicating that the observed concordance was no better than that expected by chance alone (P >.99).Conclusions: Appropriate diagnosis and therapy of chronic osteomyelitis require microbiologic cultures of the infected bone. Nonbone specimens are not valid for this purpose.