Section’s osseous slice biopsy during major amputation of lower extremity: preliminary results of prospective cohort study

BMC Infectious Diseases

Research Article

Linas Velicka¹  Aukse Mickiene²  Danguole Vaznaisiene²  Astra Vitkauskiene³  Juozas Belickas⁴  Rolandas Sleivys⁵  Kestutis Balanaska⁵  Vytautas Kymantas⁶  Arturas Spucis⁷  Anatolijus Reingardas⁷  Eric Senneville⁸  Kristina Rysevaite-Kyguoliene⁹  Dainius H. Pauza⁹  Rita Sulcaite^1,10 

[1] Department of Cardiothoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania;Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania;Department of Laboratory Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania;Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania;Department of Surgery, Kaunas Clinical Hospital, Kaunas, Lithuania;Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania;Department of Surgical Infection, Republican Hospital of Kaunas, Kaunas, Lithuania;Infectious Diseases Department, Dron Hospital, Tourcoing, France;Institute of Anatomy, Lithuanian University of Health Sciences, Kaunas, Lithuania;Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania;

关键词: Bone biopsy;    Major amputation;    Osteoarticular infections;   

DOI  :  10.1186/s12879-015-0993-x

 received in 2014-10-24, accepted in 2015-06-22,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundThe purpose of this cohort study was to assess the incidence of positive cultures in section’s osseous slice biopsy (SOB) taken at the level of major limb amputation. In case of positive cultures we sought whether the microorganisms present in SOB could take origin from the primary infection site necessitating the amputation. The impact of diabetes on culture results was also investigated.MethodsThis prospective cohort study, which aimed to confirm the results of the pilot study, analysed patients who underwent major limb amputation between 2012 and 2013 in three Lithuanian hospitals. SOBs at the amputation site (surgical bone biopsies) and percutaneous bone biopsies of the distal site were performed simultaneously during limb amputation. Tissue cultures were analysed by microbiologists, and species along with antibiograms were reported. Histopathological assessment and bacterial typing were also evaluated. A positive culture was defined as the identification of at least 1 bacteria not belonging to the skin flora, at least 2 bacteria belonging to the skin flora with the same antibiotic susceptibility profiles or the same bacteria belonging to the skin flora in two different sites. Fisher’s exact test and Student’s test were used to compare the populations and the microbiological results. The statistical significance level was set at P < 0.05.ResultsSixty-nine patients (35 males/34 females), mean age 68.7 (S = 13.6) years, including 21 (30.4 %) with diabetes underwent the major limb amputation. Forty-five amputations (65.2 %) were done above the knee. In total, 207 SOBs and 207 percutaneous distal site biopsies were studied. SOB cultures were positive in 11 (15.9 %) cases. In 5 (45.5 %) cases the same microorganisms were identified in both SOB and distal biopsy cultures. No association between culture results and presence of diabetes was identified.ConclusionsOur results suggest that, independently of the diabetes status, foot infection may silently spread along the bone and can achieve the site of major limb amputation. Additional investigations aiming to confirm this hypothesis and to evaluate a prognostic value are in progress.

【 授权许可】

CC BY   
© Vaznaisiene et al. 2015