Schweitzer M E, Deely D M, Beavis K, Gannon F
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
AJR Am J Roentgenol. 1995 May;164(5):1201-3. doi: 10.2214/ajr.164.5.7717232.
When percutaneous bone biopsy is done by radiologists, local anesthetics such as lidocaine are routinely used. Although percutaneous bone biopsy of neoplasms is well accepted, it has been suggested that this procedure not be used to diagnose osteomyelitis because of a reported bactericidal effect of lidocaine and related drugs on certain organisms. The purposes of this study were to determine if lidocaine is bactericidal in vitro and to determine if it has an effect on the culture of bacteria in specimens obtained by percutaneous bone biopsy in vivo.
The minimal inhibitory concentration and minimal bactericidal concentration of 1% lidocaine hydrochloride (10 mg/ml preserved with methylparaben) were determined in vitro for seven bacteria known to be frequent causes of osteomyelitis by using conventional clinical microbiologic methods. Percutaneous core bone biopsy for suspected osteomyelitis was done in 28 patients: 21 with and seven without the use of lidocaine. Sites sampled included vertebrae (14); calcanei, pubis, and ischia (two each); and intervertebral disks (eight). Six of the 21 patients who had percutaneous biopsy with lidocaine also had an open surgical biopsy without lidocaine. The results of cultures of the specimens were compared. Histologic evaluation and radiographic follow-up were used to identify false-negative results.
The minimal inhibitory and the minimal bactericidal concentrations, respectively, of lidocaine (in milligrams per milliliter) were as follows: Klebsiella pneumoniae, 5.0 and > 5.0; group B streptococci, 2.5 and 5.0; Staphylococcus aureus, > 5.0; and > 5.0; methicillin-resistant S. aureus, > 5.0 and > 5.0; Escherichia coli, 2.5 and > 5.0; Pseudomonas aeruginosa, 5.0 and 5.0; Salmonella species, 5.0 and > 5.0. We found no difference in bacterial growth and the number of false-negative results between patients who had biopsies with and those who had biopsies without lidocaine. Fifty percent of patients who had growth on cultures of specimens from percutaneous biopsies done with lidocaine had no growth on cultures of specimens from surgical biopsies done without lidocaine. This likely occurred because the surgical specimens were not obtained under cross-sectional imaging guidance.
Up to a 50% mixture of lidocaine has no significant effect in vitro on the bacterial growth of the seven organisms that cause osteomyelitis most frequently, and no inhibitory effect on bacterial growth was seen in biopsies done with lidocaine in vivo. The inhibitory effect of lidocaine therefore occurs at a greater concentration than is used clinically. We conclude that lidocaine used for biopsy does not interfere with the diagnosis of osteomyelitis.
放射科医生在进行经皮骨活检时，通常会使用利多卡因等局部麻醉剂。尽管经皮肿瘤骨活检已被广泛接受，但有人认为该方法不适用于诊断骨髓炎，因为据报道利多卡因及相关药物对某些微生物具有杀菌作用。本研究的目的是确定利多卡因在体外是否具有杀菌作用，以及它对经皮骨活检体内获取的标本中的细菌培养是否有影响。
采用传统临床微生物学方法，测定1%盐酸利多卡因（用对羟基苯甲酸甲酯保存，浓度为10mg/ml）对七种已知为骨髓炎常见病因的细菌的最低抑菌浓度和最低杀菌浓度。对28例疑似骨髓炎患者进行经皮芯针骨活检：21例使用利多卡因，7例未使用。采样部位包括椎体（14个）；跟骨、耻骨和坐骨（各2个）；以及椎间盘（8个）。21例使用利多卡因进行经皮活检的患者中有6例也进行了未使用利多卡因的开放性手术活检。比较标本培养结果。采用组织学评估和影像学随访来确定假阴性结果。
利多卡因的最低抑菌浓度和最低杀菌浓度（以毫克/毫升计）分别如下：肺炎克雷伯菌，5.0和>5.0；B组链球菌，2.5和5.0；金黄色葡萄球菌，>5.0和>5.0；耐甲氧西林金黄色葡萄球菌，>5.0和>5.0；大肠埃希菌，2.5和>5.0；铜绿假单胞菌，5.0和5.0；沙门菌属，5.0和>5.0。我们发现使用利多卡因活检的患者与未使用利多卡因活检的患者在细菌生长和假阴性结果数量上没有差异。在使用利多卡因进行经皮活检的标本培养中有生长的患者中，50%在未使用利多卡因的手术活检标本培养中没有生长。这可能是因为手术标本不是在横断面成像引导下获取的。
高达50%的利多卡因混合物在体外对七种最常引起骨髓炎的生物体的细菌生长没有显著影响，在体内使用利多卡因进行的活检中也未观察到对细菌生长的抑制作用。因此，利多卡因的抑制作用发生在高于临床使用的浓度。我们得出结论，用于活检的利多卡因不会干扰骨髓炎的诊断。
