Providing an Evidence Base for Tissue Sampling and Culture Interpretation in Suspected Fracture-Related Infection
| Autor: | Martin A. McNally, Mario Morgenstern, A J Brent, L K Barrett, Maria Dudareva, Bridget L. Atkins |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Adult Male medicine.medical_specialty Consensus Adolescent 030106 microbiology Sensitivity and Specificity 03 medical and health sciences Fractures Bone Young Adult 0302 clinical medicine Fracture Fixation Internal medicine Medicine Humans Surgical Wound Infection Orthopedics and Sports Medicine In patient 030212 general & internal medicine Surgical treatment Aged Suspected fracture Aged 80 and over Evidence-Based Medicine business.industry General Medicine Surgical procedures Tissue sampling Middle Aged Confidence interval Surgery Female Level iii business |
| Zdroj: | The Journal of bone and joint surgery. American volume. 103(11) |
| ISSN: | 1535-1386 |
| Popis: | Background The recent consensus definition for the diagnosis of fracture-related infection (FRI) includes the identification of indistinguishable microorganisms in at least 2 surgical deep-tissue specimens as a confirmatory criterion. However, this cut-off, and the total number of specimens from a patient with suspected FRI that should be sent for microbiological testing, have not been validated. We endeavored to estimate the accuracy of different numbers of specimens and diagnostic cut-offs for microbiological testing of deep-tissue specimens in patients undergoing surgical treatment for possible FRI. Methods A total of 513 surgical procedures in 385 patients with suspected FRI were included. A minimum of 2 surgical deep-tissue specimens were submitted for microbiological testing; 5 or more specimens were analyzed in 345 procedures (67%). FRI was defined by the presence of any confirmatory criteria other than microbiology. Resampling was utilized to model the sensitivity and specificity of diagnostic cut-offs for the number of surgical specimens yielding indistinguishable microorganisms and for the total number of specimens. The likelihood of detecting all clinically relevant microorganisms was also assessed. Results A diagnostic cut-off of at least 2 of 5 specimens with indistinguishable microorganisms identified by culture was 68% sensitive (95% confidence interval [CI], 62% to 74%) and 87% specific (95% CI, 81% to 94%) for the diagnosis of FRI. Two out of 3 specimens were 60% sensitive (95% CI, 55% to 66%) and 92% specific (95% CI, 88% to 96%). Submitting only 3 deep-tissue specimens risked missing clinically relevant microorganisms in at least 1 in 10 cases. Conclusions The present study was the first to validate microbiological criteria for the diagnosis of FRI, supporting the current confirmatory diagnostic criteria for FRI. Analysis of at least 5 deep-tissue specimens in patients with possible FRI is recommended. Level of evidence Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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