骨 SPECT/CT 能否确定四肢创伤后或慢性骨髓炎微生物鉴定的最佳部位?

IF 2.2 3区 医学 Q3 CRITICAL CARE MEDICINE Injury-International Journal of the Care of the Injured Pub Date : 2024-10-15 DOI:10.1016/j.injury.2024.111940
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引用次数: 0

摘要

简介:在治疗慢性骨髓炎(COM)和创伤后骨髓炎(PTO)时,准确的微生物鉴定至关重要。尽管骨单光子发射计算机断层扫描/计算机断层扫描(SPECT/CT)有助于定位骨髓炎病灶,但其在指导微生物取样方面的效果仍不明确。本研究旨在确定骨SPECT/CT是否能提高四肢COM或PTO的微生物鉴定率:回顾性分析了 2020 年 2 月至 2024 年 8 月期间 53 例疑似四肢 COM 或 PTO 患者。所有患者均接受了骨SPECT/CT检查,随后在手术过程中进行了微生物采样。组织样本取自 SPECT/CT 摄取较高的区域,或根据术中发现未观察到摄取的区域。对微生物鉴定率进行了分析,包括基于抗生素停用情况的亚组分析:结果:在 53 名患者中,42 名患者的骨 SPECT/CT 扫描结果呈阳性,其中 30 名患者(71.4%)鉴定出病原体。相比之下,在12名扫描结果为阴性的患者中,有1人(9.1%)能确定病原体(几率比25,P< 0.001)。骨 SPECT/CT 的灵敏度为 96.8%,总体准确率为 75.5%。当抗生素停用≥2周时,病原体识别率增至90%,而结论为50%:骨 SPECT/CT 可有效确定四肢 COM 和 PTO 微生物采样的最佳部位,尤其是在抗生素停用≥2 周时,可提高病原体检出率。
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Can bone SPECT/CT determine optimal sites for microbiological identification in post-traumatic or chronic osteomyelitis of extremities?

Introduction

Accurate microbiological identification is crucial when managing chronic osteomyelitis (COM) and post-traumatic osteomyelitis (PTO). Although bone single photon emission computed tomography/computed tomography (SPECT/CT) has helped in localizing osteomyelitis lesions, its effectiveness in guiding microbiological sampling remains unclear. This study aimed to determine whether bone SPECT/CT can improve microbiological identification rates in COM or PTO of the extremities.

Patients and methods

From February 2020 to August 2024, 53 patients with suspected COM or PTO in the extremities were retrospectively analyzed. All patients underwent bone SPECT/CT, followed by microbiological sampling during surgery. Tissue samples were taken from the areas of high SPECT/CT uptake or based on intraoperative findings where no uptake was observed. Microorganism identification rates were analyzed, including a sub-group analysis based on antibiotic discontinuation.

Results

Of the 53 patients, 42 had positive bone SPECT/CT scan findings, with pathogen identification in 30 patients (71.4 %). In contrast, pathogen identification occurred in one out of twelve patients (9.1 %) with negative findings (odds ratio 25, p< 0.001). Bone SPECT/CT demonstrated a sensitivity of 96.8 % and an overall accuracy of 75.5 %. When antibiotics had been discontinued for ≥2 weeks, the pathogen identification rate increased to 90 %, compared with 50 % for <2 weeks of discontinuation (odds ratio 10.0, p= 0.006). In a sub-group of 30 patients with adequate antibiotic discontinuation duration, a positive bone SPECT/CT scan yielded a pathogen identification rate of 90.1 % (odds ratio 60.0, p= 0.001).

Conclusion

Bone SPECT/CT effectively identifies optimal sites for microbiological sampling in COM and PTO of the extremities, particularly when antibiotics have been discontinued for ≥2 weeks, enhancing pathogen detection rates.
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来源期刊
CiteScore
4.00
自引率
8.00%
发文量
699
审稿时长
96 days
期刊介绍: Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.
期刊最新文献
Editorial Board Fracture-related infection blood-based biomarkers: Diagnostic strategies The value of current diagnostic techniques in the diagnosis of fracture-related infections: Serum markers, histology, and cultures Antimicrobial resistance: Biofilms, small colony variants, and intracellular bacteria In vivo models of infection: Large animals – Mini review on human-scale one-stage revision in a porcine osteomyelitis model
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