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The Journal of Bone and Joint Surgery, Vol 73, Issue 5 745-749, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
Accuracy of cultures of material from swabbing of the superficial aspect of the wound and needle biopsy in the preoperative assessment of osteomyelitis
CR Perry, RL Pearson and GA Miller
Washington University School of Medicine, St. Louis, Missouri.
The pathogens that were identified on cultures of material obtained by
swabbing of the superficial aspect of the wound and needle biopsy were
compared with those that were isolated from material that was obtained at
debridement from sixty patients who had post-traumatic or postoperative
osteomyelitis. The cultures of material that was obtained by superficial
swabbing of the wound and needle biopsy were inadequate for prediction of
the presence of aerobic organisms. Moreover, the failure to isolate
anaerobes from the material obtained by needle biopsy did not rule out the
presence of anaerobic organisms. Therefore, tissue for culture of aerobic
and anaerobic organisms must be obtained during operative debridement in
order to identify all pathogenic organisms. Fungi were isolated from the
material obtained by biopsy in two patients. In addition, histological
examination of the tissue obtained at biopsy led to the diagnosis of
epidermoid carcinoma in two patients in whom this diagnosis had not been
suspected before biopsy. Cultures were negative for mycobacteria in all
patients. An additional ten patients who had a tibial non-union and latent
osteomyelitis were studied. In nine of them, cultures of material obtained
by needle biopsy showed no growth. Six of these nine patients had an
exacerbation of the osteomyelitis after intramedullary nailing for the
non-union. Therefore, the absence of growth of organisms from tissue
obtained at needle biopsy does not rule out the possibility that
osteomyelitis may be reactivated after intramedullary nailing with reaming.
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