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Quantification Analysis of the Intraoperative Bacterial Contamination Rate and Level in Osteochondral Autografts
Abdulaziz Z Alomar1, Ali Mohammed Somily2, Thamer M Alraiyes3
1Orthopaedic Department, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia dr_abdulaziz@yahoo.com.
Background:
Inadvertent contamination of osteochondral (OC) autografts during harvesting and preparation can lead to significant complications and can cause the operating team to weigh the infection risk after reimplantation against discarding the OC fragment. The most commonly reported contamination mechanism is the accidental dropping of an OC fragment; however, associated contamination levels remain unclear. The rate and level of contamination during standard harvesting and preparation are also unknown.
Purpose:
To quantitatively evaluate the rate and level of bacterial contamination of OC autografts during harvesting and preparation compared with those of accidently dropped autografts.
Study Design:
Controlled laboratory study.
Methods:
Under sterile conditions, 138 fresh OC specimens were harvested and retrieved from 23 primary total knee arthroplasties (TKAs). Six OC fragments were retrieved from each TKA: 3 were used as controls, and 3 were dropped onto the operating room floor. Each specimen was incubated to allow for aerobic and anaerobic growth, and the number of colony-forming units (CFUs) per gram was calculated.
Results:
Contamination rates (positive cultures) for the control and dropped groups were 29% (n = 20/69) and 42% (n = 29/69), respectively. The difference in the contamination rate between groups was not statistically significant (P = .109). The most common organisms identified were Staphylococcus aureus (40%) in the control group and Staphylococcus epidermidis (24.1%) and Bacillus species (20.7%) in the dropped group. The contamination level (CFUs/g) for both groups was low. The median (range) CFUs/g among the contaminated specimens in the dropped and control groups were 27 (1-120) and 3 (1-15), respectively (P < .0001).
Conclusion:
A relatively high rate of OC autograft contamination can be expected during harvesting and preparation (29%) or after accidentally dropping a specimen (42%). Although the types of organisms isolated differed between specimens contaminated during harvesting and preparation and dropped specimens, the quantification of the autograft contamination level revealed a very low CFUs/g in both cases.
Clinical Relevance:
The intraoperative autograft contamination level is very low. Hence, in cases of grafts with a known contamination incident, saving and reimplanting them after proper decontamination is recommended over discarding them or using an allograft.
Insights
Osteochondral autograft contamination is common during preparation or dropping, but the bacterial levels are very low. This suggests reimplanting contaminated grafts after decontamination may be a viable option.
Area of Science:
- Orthopedic Surgery
- Microbiology
- Biomaterials Science
Background:
- Inadvertent contamination of osteochondral (OC) autografts during surgical preparation poses risks.
- Accidental dropping is a common contamination event, but its impact on bacterial load is not well understood.
- Understanding contamination rates and levels is crucial for graft viability and patient safety.
Purpose of the Study:
- To quantitatively assess bacterial contamination rates and levels in OC autografts.
- To compare contamination between standard harvesting/preparation and accidental dropping.
- To inform clinical decisions regarding contaminated grafts.
Main Methods:
- A controlled laboratory study involving 138 OC specimens from total knee arthroplasties.
- Specimens were divided into control (standard preparation) and dropped groups.
- Bacterial cultures were performed to determine colony-forming units per gram (CFUs/g).
Main Results:
- Contamination rates were 29% for control and 42% for dropped specimens (not statistically significant).
- Common organisms included Staphylococcus aureus, Staphylococcus epidermidis, and Bacillus species.
- Median CFUs/g were low in both groups (3 for control, 27 for dropped), with significant difference (P < .0001).
Conclusions:
- A significant rate of contamination occurs during OC autograft preparation and handling.
- Despite contamination, the bacterial load (CFUs/g) remains very low.
- Reimplanting contaminated grafts after decontamination is a recommended alternative to discarding them.
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