Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Infect Control Hosp Epidemiol. 2023 Apr;44(4):631-637. doi: 10.1017/ice.2022.112. Epub 2022 May 5.
To evaluate the utility of autologous bone-flap swab cultures performed at the time of cranioplasty in predicting postcranioplasty surgical site infection (SSI).
Retrospective cohort study.
Patients undergoing craniectomy (with bone-flap storage in tissue bank), followed by delayed autologous bone-flap replacement cranioplasty between January 1, 2010, and November 30, 2020.
Tertiary-care academic hospital.
We framed the bone-flap swab culture taken at the time of cranioplasty as a diagnostic test for predicting postcranioplasty SSI. We calculated, sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios.
Among 282 unique eligible cases, 16 (5.6%) developed SSI after cranioplasty. A high percentage of bone-flap swab cultures were positive at the time of craniectomy (66.7%) and cranioplasty (59.5%). Most organisms from bone-flap swab cultures were or coagulase-negative staphylococci (76%-85%), and most SSI pathogens were methicillin-susceptible (38%). Bone-flap swab culture had poor sensitivity (0.07; 95% CI, 0.01-0.31), specificity (0.4; 95% CI, 0.34-0.45), and positive likelihood ratio (0.12) for predicting postcranioplasty SSI.
Overall, autologous bone-flap swab cultures performed at the time of cranioplasty have poor utility in predicting postcranioplasty SSI. Eliminating this low-value practice would result in significant workload reductions and associated healthcare costs.
评估颅骨成形术中自体骨瓣拭子培养物在预测颅骨成形术后手术部位感染（SSI）中的作用。
回顾性队列研究。
2010 年 1 月 1 日至 2020 年 11 月 30 日期间行颅骨切除术（骨瓣储存在组织库中），随后行延迟自体骨瓣复位颅骨成形术的患者。
三级保健学术医院。
我们将颅骨成形术中采集的骨瓣拭子培养物作为预测颅骨成形术后 SSI 的诊断试验。我们计算了敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比。
在 282 例符合条件的患者中，16 例（5.6%）在颅骨成形术后发生 SSI。颅骨切除术（66.7%）和颅骨成形术（59.5%）时骨瓣拭子培养物阳性的比例较高。骨瓣拭子培养物中大多数为或凝固酶阴性葡萄球菌（76%-85%），大多数 SSI 病原体为甲氧西林敏感（38%）。骨瓣拭子培养物对预测颅骨成形术后 SSI 的敏感性（0.07；95%CI，0.01-0.31）、特异性（0.4；95%CI，0.34-0.45）和阳性似然比（0.12）均较差。
总体而言，颅骨成形术中自体骨瓣拭子培养物对预测颅骨成形术后 SSI 的作用有限。消除这种低价值的做法将显著减少工作量和相关的医疗保健成本。
