Department of Orthopaedic Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935, Cologne, Germany.
Int Orthop. 2024 Feb;48(2):337-344. doi: 10.1007/s00264-023-05981-w. Epub 2023 Sep 20.
Bone and joint infections are an important and increasing problem. Whether intraoperatively detected bacteria should be considered relevant or not is often difficult to assess. This retrospective cohort study analyzes the relevance of C. acnes cultured from deep intraoperative specimens.
All deep tissue samples collected intraoperatively between 2015 and 2020 from a quartiary care provider were evaluated for detection of C. acnes and its therapeutical consequences. Infection rates were determined according to a standardized definition and protocol and analyzed in dependence of patient's demographic data (age and gender), operative parameters (type of surgery, body region/location of surgery, and impression of the surgeon), and initiated therapy.
In 270 cases of more than 8500 samples, C. acnes was detected. In 30%, the detection was considered an infection. The number of samples taken and tested positive for C. acnes correlated significantly with its classification as a cause of infection. If more than one sample of the patient was positive, the detection was significantly more likely to be treated as infection (p < 0.001). In 76% of cases, a consultation to the infectious diseases (ID) department took place regarding the classification of the pathogen detection and the therapy to be carried out. Almost all of the tested isolates demonstrated the wild-type susceptibility for penicillin and clindamycin.
Intraoperative detection of skin-colonizing bacteria such as C. acnes is not always synonymous with infection. In particular, if other examination results contradict an infection (pathological sample without evidence of an infectious event, detection of malignant cells, etc.), the situation must be considered in a very differentiated manner. Interdisciplinary boards, for example, are suitable for this purpose. Care should be taken to obtain a sufficiently large number of tissue samples for microbiological examination to be able to better classify the result.
骨骼和关节感染是一个重要且日益严重的问题。术中检测到的细菌是否相关通常难以评估。本回顾性队列研究分析了从深部术中标本中培养出的痤疮丙酸杆菌的相关性。
评估 2015 年至 2020 年间从一家四等医疗机构采集的所有深部组织样本，以检测痤疮丙酸杆菌及其治疗效果。根据标准化定义和方案确定感染率，并根据患者的人口统计学数据（年龄和性别）、手术参数（手术类型、手术部位/区域和外科医生的印象）以及开始的治疗进行分析。
在 270 例 8500 多个样本中，检测到痤疮丙酸杆菌。其中 30%的检测结果被认为是感染。检测到的样本数量和痤疮丙酸杆菌阳性检测结果与感染的分类显著相关。如果患者的多个样本呈阳性，则更有可能将其检测结果视为感染（p<0.001）。在 76%的情况下，就病原体检测的分类和要进行的治疗咨询了传染病（ID）部门。几乎所有测试的分离株对青霉素和克林霉素均表现出野生型敏感性。
术中检测到皮肤定植细菌，如痤疮丙酸杆菌，并不总是等同于感染。特别是如果其他检查结果与感染相矛盾（无感染事件证据的病理样本、检测到恶性细胞等），则必须非常细致地考虑这种情况。例如，跨学科委员会适合用于此目的。应注意获得足够数量的组织样本进行微生物检查，以便更好地对结果进行分类。
