Division of Hematology, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Derech Sheba 2, 52621, Ramat Gan, Israel.
MetroHealth Medical Center, Case Western Reserve University, 2500 Metrohealth Dr, Cleveland, OH, 44109, USA.
Sci Rep. 2022 Jun 11;12(1):9664. doi: 10.1038/s41598-022-14059-3.
The clinical yield and benefit of performing bone marrow cultures for various clinical indications has been challenged and their clinical necessity remains debatable. We sought to assess the clinical yield and benefit of performing routine bone marrow cultures and determine whether various clinical, laboratory, and imaging parameters were predictive of a diagnostic bone marrow culture. This was a single center retrospective analysis of all patients who underwent a bone marrow study comprising bone marrow cultures from January 1, 2012, through March 1, 2018. Baseline clinical data were extracted from the institution's electronic medical records system. The analyzed cohort consisted of 139 patients with a median age of 46 years (range 4 months to 85 years). The most common indication for a bone marrow study was workup of a fever of unknown origin (105 patients, 76%) while investigation for infection in immunocompromised patients accounted for 22 cases (16%) and suspected tuberculosis was the reason for acquisition of bone marrow cultures in 6 patients (4%). Only 3 patients had positive bone marrow cultures, yielding in 2 patients a diagnosis of Mycobacterium avium and in one patient a microbiologically unclassifiable fungal infection. A univariate analysis revealed that mean age, hemoglobin level, platelet count, c-reactive protein levels, gender, indication for bone marrow study, yield of blood cultures, and contribution of imaging studies and bone marrow pathology results were not significantly different between patients with diagnostic and non-diagnostic bone marrow cultures. Mean white blood cell count was found to be significantly lower in patients with diagnostic bone marrow cultures (2.4 × 10/µL versus 8.7 × 10/µL; P = 0.038). We conclude that for most patients, performance of bone marrow cultures holds limited clinical value.
对于各种临床指征，进行骨髓培养的临床收益和益处受到了质疑，其临床必要性仍存在争议。我们旨在评估常规骨髓培养的临床收益和益处，并确定各种临床、实验室和影像学参数是否可预测诊断性骨髓培养。这是对 2012 年 1 月 1 日至 2018 年 3 月 1 日期间在一家医疗机构接受骨髓研究（包括骨髓培养）的所有患者进行的单中心回顾性分析。从该机构的电子病历系统中提取基线临床数据。分析队列包括 139 名患者，中位年龄为 46 岁（范围 4 个月至 85 岁）。进行骨髓研究最常见的指征是不明原因发热的检查（105 例，76%），而免疫功能低下患者的感染调查占 22 例（16%），怀疑结核病是 6 例（4%）患者采集骨髓培养的原因。只有 3 例患者的骨髓培养呈阳性，其中 2 例培养出鸟分枝杆菌，1 例培养出微生物无法分类的真菌感染。单变量分析显示，诊断性和非诊断性骨髓培养患者的平均年龄、血红蛋白水平、血小板计数、C 反应蛋白水平、性别、骨髓研究指征、血培养阳性率以及影像学研究和骨髓病理学结果的贡献无显著差异。发现诊断性骨髓培养患者的平均白细胞计数明显较低（2.4×10/µL 与 8.7×10/µL；P=0.038）。我们的结论是，对于大多数患者来说，骨髓培养的临床价值有限。
