CENGİZ EREN CANSÜ, Aygül ÇELİK DOĞAN, Fahri ERDOĞAN, Muharrem BABACAN

Protez gevşemelerinin etyolojik tanısında ameliyathanede hemen ekilen kültürlerin laboratuvarda ekilenler ile karşılaştırılması

Amaç: Çalışmanın amacı, ameliyat esnasında alınıp, ameliyathanede hemen ekilen materyallerin kültürlerinin, laboratuvarda ekilenlerden üstün olup olmadığını göstermektir. Hastalar ve Yöntemler: Artroplasti gevşemelerinin etyolojik tanısı hastanın prognozu ve revizyon cerrahisinin sağkalımı için önemlidir. Çalışmamızda, revizyon ameliyatı esnasında alınıp, ameliyathanede hemen ekilen örneklerin kültür sonuçlarını, laboratuvarda ekilen örneklerin kültür sonuçları ile karşılaştırdık. Çalışmaya 32 vaka dahil edildi. Ameliyat öncesinde C-reaktif protein (CRP) ve eritrosit sedimentasyon hızı (ESH) tetkikleri istendi. Hem ameliyathanede hem de sonrasında laboratuvarda ekilmek üzere sıvı, sürüntü ve doku biyopsi örneklerinin her biri ikişer adet olarak alındı. Alınan her örnek Gram boyama ile de incelendi. Bulgular: Otuz iki vakanın sekizi enfekte olarak değerlendirildi. CRP’nin enfekte grupta aseptik gruba göre anlamlı olarak yüksek olduğu (p=0,003), ESH için ise anlamlı fark olmadığı saptandı. 42 örneğin ancak üçü (%7,1) Gram pozitif boyandı. Ekimi ameliyathanede yapılan materyal grubunda sıvı örneklerde, sürüntü ve doku biyopsisi örneklerine kıyasla daha fazla üreme saptandı. Bu fark istatistiksel olarak anlamlı olarak bulundu (p<0,001). Sonuç: Sıvı örneklerde üreme, diğer örneklerdeki üreme ile karşılaştırıldığında istatistiksel olarak anlamlı bulundu (p<0,001). Bu neden ile, artroplasti revizyonlarında sıvı örneklerin alınıp kan kültürü şişelerine hemen ameliyathanede ekilmesi mikroorganizma saptama ihtimalini arttırabilir.

Anahtar Kelimeler:

Artroplasti gevşemesi, Ameliyathanede ekim, Enfekte gevşeme, Mikrobiyolojik tanı

Comparison of cultures immediately incubated intraoperatively with cultures incubated postoperatively in the laboratory for causes of periprosthetic loosening

Objectives: Our study aimed to show whether cultures that are incubated immediately in the operating room (OR) during surgery are superior to those prepared in the laboratory. Patients and Methods: The results of bacteriologic cultures of the specimens processed immediately in the OR during surgery or afterwards in the bacteriology laboratory were compared. Thirty two cases were enrolled in this study. C-reactive protein (CRP) levels and erythrocyte sedimentation rates (ESR) levels were detected preoperatively. Liquid, swab, and tissue biopsy specimens were obtained to be processed separately in the OR or in the bacteriology laboratory. Each specimen was also examined by Gram-staining. Results: Among 32 cases eight were infected. The average level of CRP was significantly higher in the infected group than in the aseptic group (p=0.003). There was no statistical significance for ESR levels between these groups. Of the eight infected patients, only three specimen out of 42 (7.1%) were Gram-positive. For the specimens processed in the operating room the isolation of the bacteria from liquid specimen cultures was found to be significantly higher than the swab, and tissue biopsy cultures (p<0.001). Conclusion: Statistical analysis showed that the isolation of the bacteria from fluid material was statistically significant (p<0.001). Therefore, we conclude that inoculation of fluid material into the blood culture bottles in the OR may increase the chance of yielding organisms.

Keywords:

Arthroplasty loosening, Intraoperative culture, Infected loosening, Microbiological diagnosis,

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1. Obrebski M, Kicinski M, Bialecki J, Marczynski W, Walczak P. An analysis of complex, life-threatening infectious complications of hip and knee joint arthroplasty based on departmental data. Pol Orthop Traumatol 2013;78:251-7.
2. Winkler T, Trampuz A, Hardt S, Janz V, Kleber C, Perka C. Periprosthetic infection after hip arthroplasty. Orthopade 2014;43:70- 8. doi: 10.1007/s00132-013-2132-y
3. Fitzgerald RH, Peterson LFA, Washington JA, Van Scoy RE, Coventry MB. Bacterial colonization of wounds and sepsis in total hip arthroplasty. J Bone Joint Surg Am 1973;55-A:1242-50.
4. Buchholz HW, Elson RA, Engelbrecht E, Lodenkaemper H, Röttger J, Siegel A. Management of deep infection of total hip replacement. J Bone Joint Surg Br 1981;63-B:342-53.
5. Levine BR, Evans BG. Use of blood culture vial specimens in intraoperative detection of infection. Clin Orthop 2001;382:222-31. doi: 10.1097/00003086-200101000-00030
6. McDonald DJ, Fitzgerald RH Jr., Ilstrup DM. Two-stage reconstruction of a total hip arthroplasty because of infection. J Bone Joint Surg Am 1989;71:828-34.
7. Spangehl MJ, Masri BA, O’Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am 1999;81:672-83.
8. Charnley J, Eftekhar N. Postoperative infection in total prosthetic replacement arthroplasty of the hip-joint. With special reference to the bacterial content of the air of the operating room. Br J Surg 1969;56:641-9. doi: 10.1002/bjs.1800560902
9. Laupacis A, Bourne R, Rorabeck C, et al. The effect of elective total hip replacement on health-related quality of life. J Bone Joint Surg Am 1993;75:1619-26.
10. Spangehl MJ, Younger ASE, Masri BA, Duncan CP. Diagnosis of infection following total hip arthroplasty. J Bone Joint Surg Am 1997;79-A:1578-88.
11. Sanzen L, Carlsson AS. The diagnostic value of C-reactive protein in infected total hip arthroplasties. J Bone Joint Surg Br 1989;71:638-41.
12. Shih LY, Wu JJ, Yang DJ. Erythrocyte sedimentation rate and C-reactive protein values in patients with total hip arthroplasty. Clin Orthop 1987;225:238-46. doi: 10.1097/00003086-198712000-00021
13. Lachiewicz PF, Rogers GD, Thomason HC. Aspiration of the hip joint before revision total hip arthroplasty. Clinical and laboratory factors influencing attainment of a positive culture. J Bone Joint Surg Am 1996;78:749-54.
14. Rorabeck CH. Salvage of the infected total knee replacement. Clin Orthop 2002;404:113-5. doi: 10.1097/00003086-200211000-00020
15. Aalto K, Osterman K, Peltola H, Rasanen J. Changes in erythrocyte sedimentation rate and c-reactive protein after total hip arthroplasty. Clin Orthop 1984;184:118-20. doi: 10.1097/00003086-198404000- 00015
16. Chimento GF, Finger S, Barrack RL. Gram stain detection of infection during revision arthroplasty. J Bone Joint Surg Br 1996;78:838-9.
17. Spangehl MJ, Masterson E, Masri BA, O’Connell JX, Duncan CP. The role of intraoperative gram stain in the diagnosis of infection during revision total hip arthroplasty. J Arthroplasty 1999;14,8:952-6. doi: 10.1016/S0883-5403(99)90009-8
18. Munoz-Mahamud E, Soriano A, Combalia A, et al. Comparison of bacterial results from conventional cultures of the periprosthetic membrane and the synovial or pseudocapsule during hip revision arthroplasty. Arch Orthop Trauma Surg 2014;134:577-83. doi: 10.1007/s00402-014-1921-z
19. Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 1996;78:512-23.