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

Abstract

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.

Keywords

• 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

Abstract

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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