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Diagnostic value of sinus-tract cultures in chronic osteomyelitis
Abstract:
Sinus-tract cultures were compared with cultures of operative specimens from 40 patients with chronic osteomyelitis. Thirty-five patients (87.5%) had a single pathogen isolated from their operative specimens. Only 44% of the sinus-tract cultures contained the operative pathogen. Isolation of Staphyloccus aureus from sinus tracts correlated with the presence of S aureus in the operative specimen. However, less than half of the sinus-tract cultures obtained from patients with S aureus osteomyelitis contained this organism. Isolation of bacteria other than S aureus from sinus tracts had a low likelihood of predicting the pathogen isolated from bone. A presumptive diagnosis of S aureus osteomyelitis is justified if S aureus is isolated from an associated sinus tract. A bacteriologic diagnosis of chronic osteomyelitis based on isolation of common pathogens other than S aureus from sinus tracts must be verified by an appropriate operative culture.
Insights
Sinus-tract cultures are unreliable for diagnosing chronic osteomyelitis, especially for pathogens other than Staphylococcus aureus. Operative specimen cultures are crucial for accurate bacteriologic diagnosis.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Chronic osteomyelitis diagnosis often relies on microbial cultures.
- Sinus tracts are a common manifestation, and their cultures are frequently used for diagnosis.
Purpose of the Study:
- To compare the diagnostic accuracy of sinus-tract cultures versus operative specimen cultures in patients with chronic osteomyelitis.
- To evaluate the reliability of sinus-tract cultures in identifying causative pathogens.
Main Methods:
- Cultures from sinus tracts and operative specimens were obtained from 40 patients diagnosed with chronic osteomyelitis.
- Microbial identification from both sample types was performed and compared.
Main Results:
- Operative specimens yielded a single pathogen in 87.5% of cases.
- Only 44% of sinus-tract cultures accurately identified the operative pathogen.
- Staphylococcus aureus isolation from sinus tracts correlated with its presence in operative specimens, but less than half of S. aureus osteomyelitis cases showed this.
- Isolation of other bacteria from sinus tracts had low predictive value for bone pathogens.
Conclusions:
- A presumptive diagnosis of Staphylococcus aureus osteomyelitis can be made if S. aureus is isolated from an associated sinus tract.
- Bacteriologic diagnosis of chronic osteomyelitis based on sinus-tract cultures for pathogens other than S. aureus requires verification with operative cultures.