Ochs B G, Kommerell M, Geiss H K, Simank H G
Orthopädische Universitätsklinik, Heidelberg.
Orthopade. 2005 Apr;34(4):345-51. doi: 10.1007/s00132-005-0771-3.
This prospective study included 63 patients with confirmed infections of soft tissue, joints, bones or implants. During 110 surgical interventions, 124 swab and deep tissue sample pairs were taken and analysed microbiologically using standard procedures.
In 40 patients who had not received prior antibiotic treatment, 57 sample pairs (swabs/tissue) were taken. In 70%, growth of microorganisms could be observed in both swabs and tissue samples. Growth in tissue sample only was observed in 14% and in 14% no growth could be detected. In 67 sample pairs taken from 23 patients who had received systemic antimicrobial treatment prior to surgery, microbial growth in both specimens was detected in 40%. Growth in tissue sample only was observed in 22% and 34% of the samples remained without detectable growth. The overall sensitivity of the tissue samples (70%) was significantly higher than in swab samples (44%) for the pretreated group.
The use of intraoperative tissue samples for microbiological diagnostics in septic orthopaedic surgery must be considered a "gold standard". The higher sensitivity of intraoperative tissue samples is particularly important in patients receiving systemic antibiotic therapy prior to surgical interventions.
本前瞻性研究纳入了63例确诊为软组织、关节、骨骼或植入物感染的患者。在110次外科手术中，采集了124对拭子和深部组织样本，并采用标准程序进行微生物学分析。
在40例未接受过抗生素治疗的患者中，采集了57对样本（拭子/组织）。在70%的样本中，拭子和组织样本均观察到微生物生长。仅在组织样本中观察到生长的占14%，14%未检测到生长。在术前接受过全身抗菌治疗的23例患者采集的67对样本中，40%的样本在两个标本中均检测到微生物生长。仅在组织样本中观察到生长的占22%，34%的样本未检测到生长。对于预处理组，组织样本的总体敏感性（70%）显著高于拭子样本（44%）。
术中组织样本用于化脓性骨科手术的微生物诊断必须被视为“金标准”。术中组织样本较高的敏感性在手术干预前接受全身抗生素治疗的患者中尤为重要。
