Anoumou M, Traoré M, Kouamé M, Gogoua R, Ouassa T, Guy V
Traumatologie Orthopédie CHU de Treichville, Abidjan, Côte d'Ivoire.
West Afr J Med. 2007 Jul-Sep;26(3):238-42. doi: 10.4314/wajm.v26i3.28318.
Post operative infections are more severe complications in bone surgery. The first stage culture on drain tip or intraoperative swab are not well known according to clear, open and aseptic orthopaedic surgery to predict wounds infections.
To show the place of the systemic bacteriological culture of an intraoperative swab and the proximal tip of the Redon in bone surgery.
This was a prospective continuous series of 92 interventions performed in the service of Orthopaedics Traumatology of Treichville University Hospital (Abidjan, Côte d'Ivoire). The lesions included were allocated into three groups based on the National Research Council classification. Group 1 consisted of 50 subjects with clean lesions and hyper clean. Group 2 was made up of 25 subjects with clean lesions contaminated or contamined ab initio while Group 3 consisted of 17 patients with the septic lesions. Fifty six men and 36 women with an average age of 36.9 years had two types of swabs culture. In the first type sample of intra operative haematoma or the pus before using antiseptic products was used; the second type of culture used the proximal tip of Redon at the time of its ablation. These two swabs were put in a sterile vial and sent to the same laboratory for culture.
The overall sepsis rate was of 24(26,1%). The microbial population was dominated by the gram negative bacilli, bacilli positive intraoperative cultures were most frequent in the group 3. 15 (88,2%). The positivity of the culture of the Redon was high in the group 2 (32%) and in the group 3 (52.9%). There was a significant difference between these two groups of surgery. The sensitivity, the specificity, and the predictive values were low. For all groups, the reports of likelihood observed didn't permit to establish a relation of cause or effect between a positive culture and the occurrence of post operative infection.
The gram negative bacilli were mostly observed on the culture of the site of infection. Although there was no significant relationshionship, it appears from the frequency that there may be a clinical link between the positive culture and open fracture.
术后感染是骨外科较为严重的并发症。根据清洁、开放和无菌的骨科手术标准，引流管尖端或术中拭子的初次培养对于预测伤口感染并不为人熟知。
展示术中拭子和雷顿引流管近端尖端的全身细菌培养在骨外科中的作用。
这是在特雷奇维尔大学医院（阿比让，科特迪瓦）创伤骨科服务部进行的一项前瞻性连续系列研究，共纳入92例干预措施。根据美国国家研究委员会分类法，将纳入的病变分为三组。第1组由50例清洁伤口和超清洁伤口的患者组成。第2组由25例初始即有清洁伤口但被污染或沾染的患者组成，而第3组由17例感染性伤口的患者组成。56名男性和36名女性，平均年龄36.9岁，进行了两种拭子培养。第一种培养使用在使用抗菌产品之前的术中血肿或脓液样本；第二种培养在拔除雷顿引流管时使用其近端尖端。这两种拭子被放入无菌小瓶中，并送至同一实验室进行培养。
总体败血症发生率为24（26.1%）。微生物群体以革兰氏阴性杆菌为主，术中培养的革兰氏阳性杆菌在第3组最为常见，为15例（88.2%）。雷顿引流管培养的阳性率在第2组较高（32%），在第3组为（52.9%）。这两组手术之间存在显著差异。敏感性、特异性和预测值较低。对于所有组，观察到的似然比报告不允许在阳性培养与术后感染的发生之间建立因果关系。
在感染部位的培养中大多观察到革兰氏阴性杆菌。虽然没有显著相关性，但从频率上看，阳性培养与开放性骨折之间似乎可能存在临床联系。
