足部慢性骨髓炎多点取材细菌培养的意义

Significance of multipoint sampling bacteria culture in chronic osteomyelitis of the foot

[目的]探讨足部骨髓炎患者清创术中不同细菌标本送检数确定足部慢性骨髓炎致病菌的能力。[方法]回顾性分析2017年10月—2022年2月105例足部慢性骨髓炎患者的临床资料,共送检细菌培养105次,其中送检套数分别为:29次(1套)、36次(3套)、40次(5套)。比较各套数检出的细菌数及检出致病菌能力。[结果]105例慢性骨髓炎患者中有82例检出细菌,其中,金黄色葡萄球菌比例占整个检出细菌总数的34.2%,其次为表皮葡萄球菌占12.2%。在105次送检细菌培养中,各套细菌检出率依次为65.5%(1套)、75.0%(3套)、及90.5%(5套);确定致病菌能力依次为85.0%(5套)、55.6%(3套),1套与5套及3套与5套细菌检出率差异均有统计学意义(P<0.05),1套与3套检出率差异无统计学意义(P>0.05)。[结论]在检出致病菌方面,术中送检5套标本检出致病菌能力最强,送检1套标本检出致病菌能力最差。因此在确定致病菌时,建议在清创术中多位点取材、至少送检5套细菌标本。

[Objective]To investigate the capacity of different bacteria-culture samplings in debridement to determine the pathogenicbacteria of foot chronic osteomyelitis.[Methods]Clinical data of 105 patients with chronic osteomyelitis of the foot from October 2017 toFebruary 2022 were retrospectively analyzed.A total of 105 bacterial cultures were sent for examination,including 29(1 set),36(3 sets)and40(5 sets).The number of bacteria detected and the ability to detect pathogenic bacteria were compared.[Results]Bacteria were detected in82 of 105 patients with chronic osteomyelitis,among which Staphylococcus aureus accounted for 34.2%of the total detected bacteria,fol-lowed by Staphylococcus epidermidis accounted for 12.2%.In the 105 samples,the detection rate of each set of bacteria was 65.5%(1 set),75.0%(3 sets),and 90.5%(5 sets).The capacity to identify pathogenic bacteria was 85.0%(5 sets),55.6%(3 sets),which were statisticallysignificant between 1 set and 5 sets,as well as 3 sets and 5 sets(P<0.05),whereas not significant between 1 set and 3 sets(P>0.05).[Con-clusion]In the detection of pathogenic bacteria,the ability of sending 5 sets of specimens for intraoperative detection is the strongest,whilesending 1 set of specimens for intraoperative detection is the worst.Therefore,when determining pathogenic bacteria,it is recommended totake multi-site samples during debridement and send at least 5 sets of bacterial samples for examination.