Orthopedic Surgery Service, University Hospital of Geneva, 24, Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.
Int J Infect Dis. 2010 May;14(5):e390-3. doi: 10.1016/j.ijid.2009.06.019. Epub 2009 Sep 6.
The value of non-bone microbiological cultures in the diagnosis of osteomyelitis with sinus tract is not clear. We aimed to establish the concordance between deep sinus tract cultures and bone cultures in cases of osteomyelitis with a cutaneous fistula.
This was a non-randomized, prospective diagnostic trial at the Orthopedic Service of the University Hospital of Geneva. Each patient with osteomyelitis with a cutaneous sinus tract had four microbiological samples taken: two consecutive sinus tract cultures with bone contact at different times (samples A-1 and A-2), surgical bone biopsy performed through the sinus tract (sample B), and a surgical bone biopsy performed through an uninfected area outside the sinus tract (sample C), the latter considered as the 'gold standard'.
One hundred and forty-one patients with 154 episodes of osteomyelitis were included in the study. When both sinus tract cultures yielded the same microorganism (86.4%), the concordance between both samples A and sample C was 96%. In the case of identical sinus tract culture infections, sensitivity was 91%, specificity 86%, and accuracy 90%. The accuracy in monomicrobial infections (50%) was higher than in polymicrobial infections (94.3% vs. 78.9%, respectively; p=0.02).
In cases of monomicrobial osteomyelitis with sinus tract, two concordant tract cultures with bone contact accurately predict the pathogen.
窦道性骨髓炎中非骨骼微生物培养的价值尚不清楚。我们旨在确定窦道性骨髓炎合并皮肤瘘管患者的深窦道培养与骨培养之间的一致性。
这是在日内瓦大学医院骨科服务处进行的一项非随机、前瞻性诊断试验。每位窦道性骨髓炎合并皮肤窦道的患者采集了四个微生物样本：两次连续的窦道培养，与不同时间的骨骼接触（样本 A-1 和 A-2），通过窦道进行的手术骨活检（样本 B），以及通过窦道外未感染区域进行的手术骨活检（样本 C），后者被认为是“金标准”。
本研究共纳入 141 例患者的 154 例骨髓炎发作。当两次窦道培养均培养出相同的微生物时（86.4%），两个样本 A 与样本 C 之间的一致性为 96%。在相同的窦道培养感染情况下，敏感性为 91%，特异性为 86%，准确性为 90%。在单一微生物感染（50%）中的准确性高于多微生物感染（分别为 94.3%和 78.9%；p=0.02）。
在窦道性骨髓炎合并单一微生物感染的情况下，两次与骨骼接触的一致窦道培养可准确预测病原体。
