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

Yıl 2014, Cilt: 27 Sayı: 2, 102 - 106, 20.05.2014

Eren Cansü Aygül Doğan Çelik Fahri Erdoğan Muharrem Babacan

Öz

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

Öz

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.

Anahtar Kelimeler

Arthroplasty loosening, Intraoperative culture, Infected loosening, Microbiological diagnosis

Kaynakça

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