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Pre-Referral Microbiology in Long Bone Infection: What Can It Tell Us?

Background: It remains unclear how accurately patients’ previous microbiology correlates with that ascertained from deep sampling in long bone infection. This study assessed the quality of microbiology referral information and compared it to the gold standard of intra-operative deep tissue sampling....

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Autores principales: Hotchen, Andrew J., Corrigan, Ruth A., Dudareva, Maria, Bernard, Andrew, Ferguson, Jamie, Atkins, Bridget L., McNally, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854536/
https://www.ncbi.nlm.nih.gov/pubmed/36671214
http://dx.doi.org/10.3390/antibiotics12010013
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author Hotchen, Andrew J.
Corrigan, Ruth A.
Dudareva, Maria
Bernard, Andrew
Ferguson, Jamie
Atkins, Bridget L.
McNally, Martin
author_facet Hotchen, Andrew J.
Corrigan, Ruth A.
Dudareva, Maria
Bernard, Andrew
Ferguson, Jamie
Atkins, Bridget L.
McNally, Martin
author_sort Hotchen, Andrew J.
collection PubMed
description Background: It remains unclear how accurately patients’ previous microbiology correlates with that ascertained from deep sampling in long bone infection. This study assessed the quality of microbiology referral information and compared it to the gold standard of intra-operative deep tissue sampling. Methods: All patients referred to a single specialist centre within the UK between January 2019 and March 2020 who received surgery for long bone infection were eligible for inclusion. Data on microbiological testing that was performed prior to referral was collected prospectively at the time of clinic appointment and prior to surgery. Pre-referral microbiology was compared to microbiology from deep tissue samples taken during surgery. Results: 141 patients met the diagnostic criteria for long bone infection and were included for analysis. Of these, 72 patients had microbiological information available at referral from 88 samples, obtained from either sinus swab (n = 40), previous surgical sampling (n = 25), biopsy (n = 19) or blood cultures (n = 4). In 65.9% of samples, pre-referral microbiology was deemed to be a non-match when compared to intra-operative samples. Factors that increased risk of a non-match included presence of a sinus (odd’s ratio (OR) 11.3 [95% CI 2.84–56.6], p = 0.001), increased duration of time from sampling (OR 2.29, [95% CI 1.23–5.90], p = 0.030) and results from prior surgical sampling (OR 23.0 [95% CI 2.80–525.6], p = 0.011). Furthermore, previous surgical debridement gave an increased risk of multi-, extensively or pan-resistant isolates cultured from intra-operative sampling (OR 3.6 [95% CI 1.5–8.7], p < 0.01). Conclusions: We have demonstrated that presence of a sinus, a long time from the sample being taken and results from prior surgical sampling are more likely to give inaccurate representation of current microbiology. Importantly, in cases with previous debridement surgery, there was an increased risk of multi drug resistant isolates which should be planned for in future treatments.
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spelling pubmed-98545362023-01-21 Pre-Referral Microbiology in Long Bone Infection: What Can It Tell Us? Hotchen, Andrew J. Corrigan, Ruth A. Dudareva, Maria Bernard, Andrew Ferguson, Jamie Atkins, Bridget L. McNally, Martin Antibiotics (Basel) Article Background: It remains unclear how accurately patients’ previous microbiology correlates with that ascertained from deep sampling in long bone infection. This study assessed the quality of microbiology referral information and compared it to the gold standard of intra-operative deep tissue sampling. Methods: All patients referred to a single specialist centre within the UK between January 2019 and March 2020 who received surgery for long bone infection were eligible for inclusion. Data on microbiological testing that was performed prior to referral was collected prospectively at the time of clinic appointment and prior to surgery. Pre-referral microbiology was compared to microbiology from deep tissue samples taken during surgery. Results: 141 patients met the diagnostic criteria for long bone infection and were included for analysis. Of these, 72 patients had microbiological information available at referral from 88 samples, obtained from either sinus swab (n = 40), previous surgical sampling (n = 25), biopsy (n = 19) or blood cultures (n = 4). In 65.9% of samples, pre-referral microbiology was deemed to be a non-match when compared to intra-operative samples. Factors that increased risk of a non-match included presence of a sinus (odd’s ratio (OR) 11.3 [95% CI 2.84–56.6], p = 0.001), increased duration of time from sampling (OR 2.29, [95% CI 1.23–5.90], p = 0.030) and results from prior surgical sampling (OR 23.0 [95% CI 2.80–525.6], p = 0.011). Furthermore, previous surgical debridement gave an increased risk of multi-, extensively or pan-resistant isolates cultured from intra-operative sampling (OR 3.6 [95% CI 1.5–8.7], p < 0.01). Conclusions: We have demonstrated that presence of a sinus, a long time from the sample being taken and results from prior surgical sampling are more likely to give inaccurate representation of current microbiology. Importantly, in cases with previous debridement surgery, there was an increased risk of multi drug resistant isolates which should be planned for in future treatments. MDPI 2022-12-22 /pmc/articles/PMC9854536/ /pubmed/36671214 http://dx.doi.org/10.3390/antibiotics12010013 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hotchen, Andrew J.
Corrigan, Ruth A.
Dudareva, Maria
Bernard, Andrew
Ferguson, Jamie
Atkins, Bridget L.
McNally, Martin
Pre-Referral Microbiology in Long Bone Infection: What Can It Tell Us?
title Pre-Referral Microbiology in Long Bone Infection: What Can It Tell Us?
title_full Pre-Referral Microbiology in Long Bone Infection: What Can It Tell Us?
title_fullStr Pre-Referral Microbiology in Long Bone Infection: What Can It Tell Us?
title_full_unstemmed Pre-Referral Microbiology in Long Bone Infection: What Can It Tell Us?
title_short Pre-Referral Microbiology in Long Bone Infection: What Can It Tell Us?
title_sort pre-referral microbiology in long bone infection: what can it tell us?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9854536/
https://www.ncbi.nlm.nih.gov/pubmed/36671214
http://dx.doi.org/10.3390/antibiotics12010013
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