Is there concordance between bone and tendon cultures in patients with foot tissue loss?

Abstract Background Deep infections of the extremities are a challenge that threaten limb salvage. Objectives To investigate whether the results of bone and deep tissue cultures from patients with trophic limb ulcers coincide. Methods A retrospective study was conducted with data from 54 patients with deep trophic limb ulcers admitted to the Complexo Hospitalar Universitário Professor Edgard Santos, Salvador (BA), Brazil. The study analyzed all patients for whom cultures of material from foot wounds in patients with tissue loss had been performed using two specimen types: bone and fragments of deep tendon. The study analyzed concordance between the two sample types and total number of microorganisms and numbers of microorganisms by Gram staining in both samples. Results The mean age of the 54 patients in the sample was 63.6 years, 80% had PAOD, 70% were diabetic, and 72% were hypertensive. Analysis of the cultures showed that 28 (52%) pairs of samples from the 54 patients exhibited complete concordance, with the same microorganisms grown from fragments of deep tendon and bone. There was partial disagreement in 13 samples (24%) and total disagreement in 13 (24%). On average, 1.62 microorganisms were isolated from deep tendon fragments and 1.72 were isolated from bone samples. Analyzing Gram-positive microorganisms separately, the mean number of species grown was 0.48 for tendon cultures and 0.44 for bone cultures. In contrast, the mean number of Gram-negative microorganisms isolated was 1.14 for tendon samples and 1.27 for bone samples. Conclusions Around half of the patients with foot tissue loss had bone and tendon cultures that coincided exactly.

摘要 背景：四肢深部感染是危及肢体挽救的临床难题。
研究目的：探讨肢体营养性溃疡患者的骨组织与深部组织培养结果是否具有一致性。
研究方法：本研究为回顾性研究，纳入巴西巴伊亚州萨尔瓦多市埃德加·桑托斯教授大学综合医院（Complexo Hospitalar Universitário Professor Edgard Santos）收治的54例肢体深部营养性溃疡患者。本研究对所有存在软组织缺损的足部伤口标本，采用骨组织与深部肌腱碎片两类样本进行培养，分析两类样本的培养结果一致性，同时对比两类样本中的微生物总数，以及经革兰染色分型后的微生物数量分布。
研究结果：本队列54例患者的平均年龄为63.6岁，其中80%合并外周动脉闭塞性疾病（PAOD），70%为糖尿病患者，72%患有高血压。培养结果分析显示，54对患者标本中，28例（52%）呈现完全一致的培养结果，即深部肌腱碎片与骨组织培养得到的微生物完全相同；13例（24%）标本存在部分结果不一致，另有13例（24%）完全不一致。平均而言，从深部肌腱碎片中分离得到1.62株微生物，骨组织标本中分离得到1.72株微生物。单独分析革兰阳性菌时，肌腱培养的平均菌种数为0.48株，骨组织培养为0.44株；与之相反，肌腱样本中分离得到的革兰阴性菌平均数量为1.14株，骨组织样本为1.27株。
研究结论：约半数存在足部软组织缺损的患者，其骨组织与肌腱培养结果完全一致。