Darouiche R O, Landon G C, Klima M, Musher D M, Markowski J
Department of Medicine, Baylor College of Medicine, Houston, Tex.
Arch Intern Med. 1994 Apr 11;154(7):753-8.
Pressure sores may be associated with underlying osteomyelitis that is difficult to differentiate clinically from infection or colonization of adjacent soft tissue. Cultures of bone specimens are frequently contaminated with organisms residing in adjacent soft tissue. The three objectives of this cohort study were to (1) determine the accuracy of clinical evaluation for osteomyelitis; (2) evaluate the potential role of quantitative cultures of bone in differentiating osteomyelitis from soft-tissue infection or colonization; and (3) assess the impact of treating osteomyelitis on the outcome of pressure sores.
Thirty-six patients with pressure sores related to spinal cord injury or cerebrovascular accident underwent clinical evaluation for osteomyelitis, followed by percutaneous needle biopsy of bone. Routine semiquantitative and quantitative, aerobic and anaerobic cultures of bone specimens were performed. Pathologic examination of bone tissue was used as the standard criterion for diagnosing osteomyelitis.
Six (17%) of 36 patients were diagnosed by pathologic examination as having osteomyelitis. The sensitivity and specificity of clinical evaluation were 33% and 60%, respectively. When positive, quantitative bone cultures yielded a similar number of bacterial isolates and a comparable range of bacterial concentration in patients with osteomyelitis vs those without osteomyelitis. Pressure sores healed in all six patients with osteomyelitis after appropriate therapy.
Clinical evaluation for osteomyelitis is often inaccurate. Pathologic examination of bone tissue is required for definitive diagnosis of osteomyelitis. Quantitative bone cultures do not help differentiate osteomyelitis from infection or colonization of adjacent soft tissue. It is possible that treatment of osteomyelitis may improve the outcome of associated pressure sores.
压疮可能与潜在的骨髓炎相关，而骨髓炎在临床上很难与相邻软组织的感染或定植相区分。骨标本培养常被相邻软组织中的微生物污染。这项队列研究的三个目的是：（1）确定骨髓炎临床评估的准确性；（2）评估骨定量培养在区分骨髓炎与软组织感染或定植方面的潜在作用；（3）评估治疗骨髓炎对压疮结局的影响。
36例因脊髓损伤或脑血管意外导致压疮的患者接受了骨髓炎的临床评估，随后进行了经皮骨穿刺活检。对骨标本进行常规半定量和定量需氧及厌氧培养。骨组织的病理检查用作诊断骨髓炎的标准。
36例患者中有6例（17%）经病理检查诊断为骨髓炎。临床评估的敏感性和特异性分别为33%和60%。当骨定量培养结果为阳性时，骨髓炎患者与非骨髓炎患者的细菌分离株数量和细菌浓度范围相似。6例骨髓炎患者经适当治疗后压疮均愈合。
骨髓炎的临床评估往往不准确。明确诊断骨髓炎需要进行骨组织病理检查。骨定量培养无助于区分骨髓炎与相邻软组织的感染或定植。治疗骨髓炎可能改善相关压疮的结局。
