GeneralG19Osteomyelitis幻灯片.pptVIP

* * * * * * * * * * * * Good Morning. I am here to speak with you about the Fate of Patients with a Surprise Positive Culture After Nonunion Surgery. I would like to thank my co-authors from Boston University, Washington University, and Michigan State. I would also like to thank the OTA for allowing me to speak with you this morning. In total, there were 460 patients each of whom had cultures sent from multiple areas of the nonunion. 98 patients, 21% , had “surprise” positive cultures, while the other 362 had expectedly negative cultures. * As you can see, the bacteria isolated from culture covered a wide spectrum of species, with coag-negative staph, MRSA and pseudomonas as the most common. 4 were multibacterial * Of the 98 patients with positive cultures, 90 were treated with antibiotics, generally for a 6 to 8 week duration. 8 patients were not treated with antibiotics because the cultures were “presumed contaminants” based upon infectious disease consultation. * For the patients who had a positive culture and were treated with antibiotics, 73% of the 90 patients healed after their index nonunion surgery as opposed to the 96% of patients with negative cultures who healed. This difference is statistically significant. * 12% of these 90 patients remained infected after their index nonunion surgery, as opposed to the 4% of patients with negative cultures. This difference is statistically significant. * At final follow-up, including all secondary interventions, 95% of the culture positive patients eventually healed. However, 24 had additional procedures for either debridement or to gain union, resulting in 4 infected nonunions, of which 2 had below-knee amputations. All culture negative patients healed with 15 requiring additional procedures. Again, this was statistically significant. * Of the 98 positive cultures, there were 8 patients who were NOT treated with antibiotics because the cultures were deemed “contaminants” by infectious disease specialist