PDF(Pubmed)
Abstract：
BACKGROUND: In pre-operatively presumed aseptic nonunions, the definitive diagnosis of infection relies on intraoperative cultures. Our primary objective was to determine (1) the rate of surprise positive intraoperative cultures in presumed aseptic long-bone nonunion (surprise positive culture nonunion), and (2) the rate of surprise positive cultures that represent infection vs. contamination. Secondary objectives were to determine the healing and secondary surgery rates and to identify cultured micro-organisms.
METHODS: We performed a systematic literature search of PubMed, Embase and Cochrane Libraries from 1980 until December 2021. We included studies reporting on ≥ 10 adult patients with a presumed aseptic long-bone nonunion, treated with a single-stage surgical protocol, of which intraoperative cultures were reported. We performed a meta-analysis for: (1) the rates of surprise positive culture nonunion, surprise infected nonunion, and contaminated culture nonunion, and (2) healing and (3) secondary surgery rates for each culture result. Risk of bias was assessed using the QUADAS-2 tool.
RESULTS: 21 studies with 2,397 patients with a presumed aseptic nonunion were included. The rate of surprise positive culture nonunion was 16% (95%CI: 10-22%), of surprise infected nonunion 10% (95%CI: 5-16%), and of contaminated culture nonunion 3% (95%CI: 1-5%). The secondary surgery rate for surprise positive culture nonunion was 22% (95%CI: 9-38%), for surprise infected nonunion 14% (95%CI 6-22%), for contaminated culture nonunion 4% (95%CI: 0-19%), and for negative culture nonunion 6% (95CI: 1-13%). The final healing rate was 98% to 100% for all culture results. Coagulase-negative staphylococci accounted for 59% of cultured micro-organisms.
CONCLUSIONS: These results suggest that surprise positive cultures play a role in the clinical course of a nonunion and that culturing is important in determining the etiology of nonunion, even if the pre-operative suspicion for infection is low. High healing rates can be achieved in presumed aseptic nonunions, regardless of the definitive intraoperative culture result.
METHODS: We performed a systematic literature search of PubMed, Embase and Cochrane Libraries from 1980 until December 2021. We included studies reporting on ≥ 10 adult patients with a presumed aseptic long-bone nonunion, treated with a single-stage surgical protocol, of which intraoperative cultures were reported. We performed a meta-analysis for: (1) the rates of surprise positive culture nonunion, surprise infected nonunion, and contaminated culture nonunion, and (2) healing and (3) secondary surgery rates for each culture result. Risk of bias was assessed using the QUADAS-2 tool.
RESULTS: 21 studies with 2,397 patients with a presumed aseptic nonunion were included. The rate of surprise positive culture nonunion was 16% (95%CI: 10-22%), of surprise infected nonunion 10% (95%CI: 5-16%), and of contaminated culture nonunion 3% (95%CI: 1-5%). The secondary surgery rate for surprise positive culture nonunion was 22% (95%CI: 9-38%), for surprise infected nonunion 14% (95%CI 6-22%), for contaminated culture nonunion 4% (95%CI: 0-19%), and for negative culture nonunion 6% (95CI: 1-13%). The final healing rate was 98% to 100% for all culture results. Coagulase-negative staphylococci accounted for 59% of cultured micro-organisms.
CONCLUSIONS: These results suggest that surprise positive cultures play a role in the clinical course of a nonunion and that culturing is important in determining the etiology of nonunion, even if the pre-operative suspicion for infection is low. High healing rates can be achieved in presumed aseptic nonunions, regardless of the definitive intraoperative culture result.
摘要：
背景：在术前假定的无菌性骨不愈合中，感染的明确诊断依赖于术中培养.我们的主要目标是确定（1）假定的无菌长骨不愈合（意外阳性培养不愈合）中意外阳性的术中培养的发生率，和（2）代表感染与意外阳性文化的比率污染。次要目标是确定愈合和二次手术率并鉴定培养的微生物。
方法：我们对PubMed进行了系统的文献检索，Embase和Cochrane图书馆从1980年到2021年12月。我们纳入了报告≥10名成人患者的研究，这些患者假定为无菌长骨不愈合，采用单阶段手术方案治疗，其中报告了术中培养。我们进行了荟萃分析：(1)令人惊讶的积极文化不愈合的比率，意外感染骨不连，和受污染的文化不愈合，（2）每个培养结果的愈合和（3）二次手术率。使用QUADAS-2工具评估偏倚风险。
结果：21项研究纳入2,397例假定为无菌性骨不连的患者。意外阳性文化不愈合率为16%(95CI:10-22%)，意外感染的不愈合10%(95CI:5-16%)，和受污染的文化不愈合3%（95CI：1-5%）。意外阳性文化骨不连的二次手术率为22％（95CI：9-38％），对于意外感染的不愈合14%（95CI6-22%），受污染的文化不愈合4%(95CI:0-19%)，阴性培养不愈合占6%(95CI:1-13%)。所有培养结果的最终治愈率为98%至100%。凝固酶阴性葡萄球菌占培养微生物的59%。
结论：这些结果表明，令人惊讶的阳性培养在不愈合的临床过程中起作用，并且培养在确定不愈合的病因方面很重要。即使术前怀疑感染的可能性很低。在假定的无菌性不愈合中可以实现高治愈率，无论明确的术中培养结果。
方法：我们对PubMed进行了系统的文献检索，Embase和Cochrane图书馆从1980年到2021年12月。我们纳入了报告≥10名成人患者的研究，这些患者假定为无菌长骨不愈合，采用单阶段手术方案治疗，其中报告了术中培养。我们进行了荟萃分析：(1)令人惊讶的积极文化不愈合的比率，意外感染骨不连，和受污染的文化不愈合，（2）每个培养结果的愈合和（3）二次手术率。使用QUADAS-2工具评估偏倚风险。
结果：21项研究纳入2,397例假定为无菌性骨不连的患者。意外阳性文化不愈合率为16%(95CI:10-22%)，意外感染的不愈合10%(95CI:5-16%)，和受污染的文化不愈合3%（95CI：1-5%）。意外阳性文化骨不连的二次手术率为22％（95CI：9-38％），对于意外感染的不愈合14%（95CI6-22%），受污染的文化不愈合4%(95CI:0-19%)，阴性培养不愈合占6%(95CI:1-13%)。所有培养结果的最终治愈率为98%至100%。凝固酶阴性葡萄球菌占培养微生物的59%。
结论：这些结果表明，令人惊讶的阳性培养在不愈合的临床过程中起作用，并且培养在确定不愈合的病因方面很重要。即使术前怀疑感染的可能性很低。在假定的无菌性不愈合中可以实现高治愈率，无论明确的术中培养结果。
