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Home > Archives > Volume 20, No 11 (2022) > Article

DOI: 10.14704/nq.2022.20.11.NQ66259

No concordance between bone and non-bone specimens in cases of chronic osteomyelitis: An observational study

Dr Rahul Rishi, Dr. Vaibhav Agarwal, Dr Sonal Sharma, Dr. Roshni Agarwal

Abstract

Background: The correct diagnosis and treatment of the bone-infecting organism are extremely important for determining the prognosis of chronic osteomyelitis. Many people believe that non-bone specimens can replace bone cultures because the current knowledge on choosing the optimal specimen for culture is unclear. In this study, bone cultures are compared to non-bone specimens' microbiology as the gold standard for diagnosis. Methods: A retrospective observational investigation of 50 patients with bacterial chronic osteomyelitis in a hospital in North India.COM caused by Staphylococcus aureus were analyzed independently and combined with all other etiologies. Concordance of the specimens from monomicrobial and polymicrobial COM were analyzed in relation with the site of surgical access to the bone sampled (intact skin versus infected soft tissues). Also, sequestrum and bone cultures were analyzed independently and together, to check if the first were concordant more often than the second with non-bone specimens. Results:Concordance between both specimens for all etiologic agents was 28%, for Staphylococcus aureus 38%, and for organisms other than S. aureus 19%.After removing the majority of these potential sources of confusion, we only discovered a 28% concordance between non-bone and bone specimens. In other words, 72% of patients with COM would not benefit from antimicrobial therapy directed by antibiograms of bacteria obtained from non-bone tissues. More specifically, 36% of patients would not need an antibiotic prescription, while 52% of patients would not receive enough of one. Conclusions: Because the microbiology of non-bone specimens differs significantly from that of bone, it is impossible to diagnose or treat chronic osteomyelitis using cultures of these specimens.

Keywords

The correct diagnosis and treatment of the bone-infecting organism are extremely important for determining the prognosis of chronic osteomyelitis

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