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Erschienen in: Acta Neurochirurgica 2/2013

01.02.2013 | Experimental Research

Microbial contamination assessment of cryostored autogenous cranial bone flaps: should bone biopsies or swabs be performed?

verfasst von: Ivan P. Bhaskar, Timothy J. J. Inglis, Jacintha Bowman, Gabriel Y. F. Lee

Erschienen in: Acta Neurochirurgica | Ausgabe 2/2013

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Abstract

Background

Autogenous cranioplasty infection requiring bone flap removal is under-recognised as a major complication causing significant morbidity. Microbial contamination of stored bone flaps may be a significant contributing factor. Current infection control practices and storage procedures vary. It is not known whether ‘superficial’ swabs or bone cultures provide a more accurate assessment.

Method

Twenty-five skull flaps that were cryo-stored for more than 6 months were studied. Two swab samples (superficial and deep) and a bone biopsy sample were taken from each skull flap sample and cultured. Half blood agar and half chocolate agar plates were inoculated with the swabs for anaerobic and aerobic cultures respectively. The bone biopsy samples were cultured in brain-heart broth and subcultured similar to the swabs for 5 days.

Results

Incidence of microbial contamination was 20 % in the bone flaps studied. One swab culture and five bone biopsy cultures were positive for bacterial growth, all of which contained Propionibacterium acnes (p = 0.014). Positive cultures were from bone flaps stored less than 18 months, whereas no growth was obtained from bone flaps that were stored longer (p = 0.014).

Conclusions

Bone biopsy culture is a more sensitive technique of assessing microbial contamination of cryo-stored autogenous bone flaps than swab cultures. The clinical implications of in vitro demonstration of microbial contamination require further study.
Literatur
1.
Zurück zum Zitat Auguste K, McDermott M (2006) Salvage of infected craniotomy bone flaps with the wash-in, wash-out indwelling antibiotic irrigation system. Technical note and case series of 12 patients. J Neurosurg 105:640–644PubMedCrossRef Auguste K, McDermott M (2006) Salvage of infected craniotomy bone flaps with the wash-in, wash-out indwelling antibiotic irrigation system. Technical note and case series of 12 patients. J Neurosurg 105:640–644PubMedCrossRef
2.
Zurück zum Zitat Bhaskar IP, Zaw NN, Zheng M, Lee GY (2011) Bone flap storage following craniectomy: a survey of practices in major Australian neurosurgical centres. ANZ J Surg 81:137–141PubMedCrossRef Bhaskar IP, Zaw NN, Zheng M, Lee GY (2011) Bone flap storage following craniectomy: a survey of practices in major Australian neurosurgical centres. ANZ J Surg 81:137–141PubMedCrossRef
3.
Zurück zum Zitat Brook I (2002) Meningitis and shunt infection caused by anaerobic bacteria in children. Pediatr Neurol 26:99–105PubMedCrossRef Brook I (2002) Meningitis and shunt infection caused by anaerobic bacteria in children. Pediatr Neurol 26:99–105PubMedCrossRef
4.
Zurück zum Zitat Cheng Y, Weng H, Yang J, Lee M, Wang T, Chang C (2008) Factors affecting graft infection after cranioplasty. J Clin Neurosci 15:1115–1119PubMedCrossRef Cheng Y, Weng H, Yang J, Lee M, Wang T, Chang C (2008) Factors affecting graft infection after cranioplasty. J Clin Neurosci 15:1115–1119PubMedCrossRef
5.
Zurück zum Zitat Critchley G, Strachan R (1996) Postoperative subdural empyema caused by Propionibacterium acnes–a report of two cases. Br J Neurosurg 10:321–323PubMedCrossRef Critchley G, Strachan R (1996) Postoperative subdural empyema caused by Propionibacterium acnes–a report of two cases. Br J Neurosurg 10:321–323PubMedCrossRef
6.
Zurück zum Zitat Dashti S, Baharvahdat H, Spetzler R, Sauvageau E, Chang S, Stiefel M, Park M, Bambakidis N (2008) Operative intracranial infection following craniotomy. Neurosurg Focus 24:E10PubMedCrossRef Dashti S, Baharvahdat H, Spetzler R, Sauvageau E, Chang S, Stiefel M, Park M, Bambakidis N (2008) Operative intracranial infection following craniotomy. Neurosurg Focus 24:E10PubMedCrossRef
7.
Zurück zum Zitat Delgado-López P, Martín-Velasco V, Castilla-Díez J, Galacho-Harriero A, Rodríguez-Salazar A (2009) Preservation of bone flap after craniotomy infection. Neurocirugia (Astur) 20:124–131 Delgado-López P, Martín-Velasco V, Castilla-Díez J, Galacho-Harriero A, Rodríguez-Salazar A (2009) Preservation of bone flap after craniotomy infection. Neurocirugia (Astur) 20:124–131
8.
9.
Zurück zum Zitat Ghosh M, Talwani R, Gilliam B (2009) Propionibacterium skull osteomyelitis treated with daptomycin. Clin Neurol Neurosurg 111:610–612PubMedCrossRef Ghosh M, Talwani R, Gilliam B (2009) Propionibacterium skull osteomyelitis treated with daptomycin. Clin Neurol Neurosurg 111:610–612PubMedCrossRef
10.
Zurück zum Zitat Gooch M, Gin G, Kenning T, German J (2009) Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 26:E9PubMedCrossRef Gooch M, Gin G, Kenning T, German J (2009) Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurg Focus 26:E9PubMedCrossRef
11.
Zurück zum Zitat Grossman N, Shemesh-Jan H, Merkin V, Gideon M, Cohen A (2007) Deep-freeze preservation of cranial bones for future cranioplasty: nine years of experience in Soroka University Medical Center. Cell Tissue Bank 8:243–246PubMedCrossRef Grossman N, Shemesh-Jan H, Merkin V, Gideon M, Cohen A (2007) Deep-freeze preservation of cranial bones for future cranioplasty: nine years of experience in Soroka University Medical Center. Cell Tissue Bank 8:243–246PubMedCrossRef
12.
Zurück zum Zitat Inamasu J, Kuramae T, Nakatsukasa M (2010) Does difference in the storage method of bone flaps after decompressive craniectomy affect the incidence of surgical site infection after cranioplasty? Comparison between subcutaneous pocket and cryopreservation. J Trauma 68:183–187, discussion 187PubMedCrossRef Inamasu J, Kuramae T, Nakatsukasa M (2010) Does difference in the storage method of bone flaps after decompressive craniectomy affect the incidence of surgical site infection after cranioplasty? Comparison between subcutaneous pocket and cryopreservation. J Trauma 68:183–187, discussion 187PubMedCrossRef
13.
Zurück zum Zitat Iwama T, Yamada J, Imai S, Shinoda J, Funakoshi T, Sakai N (2003) The use of frozen autogenous bone flaps in delayed cranioplasty revisited. Neurosurgery 52:591–596, discussion 595-596PubMedCrossRef Iwama T, Yamada J, Imai S, Shinoda J, Funakoshi T, Sakai N (2003) The use of frozen autogenous bone flaps in delayed cranioplasty revisited. Neurosurgery 52:591–596, discussion 595-596PubMedCrossRef
14.
Zurück zum Zitat James L, Ibrahim T, Esler C (2004) Microbiological culture results for the femoral head. Are they important to the donor? J Bone Joint Surg Br 86:797–800PubMedCrossRef James L, Ibrahim T, Esler C (2004) Microbiological culture results for the femoral head. Are they important to the donor? J Bone Joint Surg Br 86:797–800PubMedCrossRef
15.
Zurück zum Zitat Jho D, Neckrysh S, Hardman J, Charbel F, Amin-Hanjani S (2007) Ethylene oxide gas sterilization: a simple technique for storing explanted skull bone. Technical note. J Neurosurg 107:440–445PubMedCrossRef Jho D, Neckrysh S, Hardman J, Charbel F, Amin-Hanjani S (2007) Ethylene oxide gas sterilization: a simple technique for storing explanted skull bone. Technical note. J Neurosurg 107:440–445PubMedCrossRef
16.
Zurück zum Zitat Vigorita VJ (2008) Orthopaedic pathology. Lippincott Williams & Wilkins, Philadelphia Vigorita VJ (2008) Orthopaedic pathology. Lippincott Williams & Wilkins, Philadelphia
17.
Zurück zum Zitat Kamme C, Soltesz V, Sundbärg G (1984) Aerobic and anaerobic bacteria in neurosurgical infections. Per-operative culture with flexible contact agar film. J Hosp Infect 5:147–154PubMedCrossRef Kamme C, Soltesz V, Sundbärg G (1984) Aerobic and anaerobic bacteria in neurosurgical infections. Per-operative culture with flexible contact agar film. J Hosp Infect 5:147–154PubMedCrossRef
18.
Zurück zum Zitat Kelly M, Fourney D, Guzman R, Sadanand V, Griebel R, Sanche S (2006) Propionibacterium acnes infections after cranial neurosurgery. Can J Neurol Sci 33:292–295PubMed Kelly M, Fourney D, Guzman R, Sadanand V, Griebel R, Sanche S (2006) Propionibacterium acnes infections after cranial neurosurgery. Can J Neurol Sci 33:292–295PubMed
19.
Zurück zum Zitat Korinek A (1997) Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidémiologie Hygiène et Prévention. Neurosurgery 41:1073–1079, discussion 1079-1081PubMedCrossRef Korinek A (1997) Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidémiologie Hygiène et Prévention. Neurosurgery 41:1073–1079, discussion 1079-1081PubMedCrossRef
20.
Zurück zum Zitat Matsuno A, Tanaka H, Iwamuro H, Takanashi S, Miyawaki S, Nakashima M, Nakaguchi H, Nagashima T (2006) Analyses of the factors influencing bone graft infection after delayed cranioplasty. Acta Neurochir (Wien) 148:535–540, discussion 540CrossRef Matsuno A, Tanaka H, Iwamuro H, Takanashi S, Miyawaki S, Nakashima M, Nakaguchi H, Nagashima T (2006) Analyses of the factors influencing bone graft infection after delayed cranioplasty. Acta Neurochir (Wien) 148:535–540, discussion 540CrossRef
21.
Zurück zum Zitat Murray B, Karchmer A, Moellering RJ (1980) Diphtheroid prosthetic valve endocarditis. A study of clinical features and infecting organisms. Am J Med 69:838–848PubMedCrossRef Murray B, Karchmer A, Moellering RJ (1980) Diphtheroid prosthetic valve endocarditis. A study of clinical features and infecting organisms. Am J Med 69:838–848PubMedCrossRef
22.
Zurück zum Zitat Nagayama K, Yoshikawa G, Somekawa K, Kohno M, Segawa H, Sano K, Shiokawa Y, Saito I (2002) Cranioplasty using the patient’s autogenous bone preserved by freezing–an examination of post-operative infection rates. No Shinkei Geka 30:165–169PubMed Nagayama K, Yoshikawa G, Somekawa K, Kohno M, Segawa H, Sano K, Shiokawa Y, Saito I (2002) Cranioplasty using the patient’s autogenous bone preserved by freezing–an examination of post-operative infection rates. No Shinkei Geka 30:165–169PubMed
23.
Zurück zum Zitat Nisbet M, Briggs S, Ellis-Pegler R, Thomas M, Holland D (2007) Propionibacterium acnes: an under-appreciated cause of post-neurosurgical infection. J Antimicrob Chemother 60:1097–1103PubMedCrossRef Nisbet M, Briggs S, Ellis-Pegler R, Thomas M, Holland D (2007) Propionibacterium acnes: an under-appreciated cause of post-neurosurgical infection. J Antimicrob Chemother 60:1097–1103PubMedCrossRef
24.
Zurück zum Zitat Noble R, Overman S (1987) Propionibacterium acnes osteomyelitis: case report and review of the literature. J Clin Microbiol 25:251–254PubMed Noble R, Overman S (1987) Propionibacterium acnes osteomyelitis: case report and review of the literature. J Clin Microbiol 25:251–254PubMed
26.
Zurück zum Zitat Osawa M, Hara H, Ichinose Y, Koyama T, Kobayashi S, Sugita Y (1990) Cranioplasty with a frozen and autoclaved bone flap. Acta Neurochir (Wien) 102:38–41CrossRef Osawa M, Hara H, Ichinose Y, Koyama T, Kobayashi S, Sugita Y (1990) Cranioplasty with a frozen and autoclaved bone flap. Acta Neurochir (Wien) 102:38–41CrossRef
27.
Zurück zum Zitat Prolo D, Burres K, McLaughlin W, Christensen A (1979) Autogenous skull cranioplasty: fresh and preserved (frozen), with consideration of the cellular response. Neurosurgery 4:18–29PubMedCrossRef Prolo D, Burres K, McLaughlin W, Christensen A (1979) Autogenous skull cranioplasty: fresh and preserved (frozen), with consideration of the cellular response. Neurosurgery 4:18–29PubMedCrossRef
28.
Zurück zum Zitat Schültke E, Hampl J, Jatzwauk L, Krex D, Schackert G (1999) An easy and safe method to store and disinfect explanted skull bone. Acta Neurochir (Wien) 141:525–528CrossRef Schültke E, Hampl J, Jatzwauk L, Krex D, Schackert G (1999) An easy and safe method to store and disinfect explanted skull bone. Acta Neurochir (Wien) 141:525–528CrossRef
29.
Zurück zum Zitat Skinner P, Taylor A, Coakham H (1978) Propionibacteria as a cause of shunt and postneurosurgical infections. J Clin Pathol 31:1085–1090PubMedCrossRef Skinner P, Taylor A, Coakham H (1978) Propionibacteria as a cause of shunt and postneurosurgical infections. J Clin Pathol 31:1085–1090PubMedCrossRef
30.
Zurück zum Zitat Sommerville S, Johnson N, Bryce S, Journeaux S, Morgan D (2000) Contamination of banked femoral head allograft: incidence, bacteriology and donor follow up. Aust N Z J Surg 70:480–484PubMedCrossRef Sommerville S, Johnson N, Bryce S, Journeaux S, Morgan D (2000) Contamination of banked femoral head allograft: incidence, bacteriology and donor follow up. Aust N Z J Surg 70:480–484PubMedCrossRef
31.
Zurück zum Zitat Thompson T, Albright A (1998) Propionibacterium [correction of Proprionibacterium] acnes infections of cerebrospinal fluid shunts. Childs Nerv Syst 14:378–380PubMedCrossRef Thompson T, Albright A (1998) Propionibacterium [correction of Proprionibacterium] acnes infections of cerebrospinal fluid shunts. Childs Nerv Syst 14:378–380PubMedCrossRef
32.
Zurück zum Zitat Viraraghavan R, Jantausch B, Campos J (2004) Late-onset central nervous system shunt infections with Propionibacterium acnes: diagnosis and management. Clin Pediatr (Phila) 43:393–397CrossRef Viraraghavan R, Jantausch B, Campos J (2004) Late-onset central nervous system shunt infections with Propionibacterium acnes: diagnosis and management. Clin Pediatr (Phila) 43:393–397CrossRef
Metadaten
Titel
Microbial contamination assessment of cryostored autogenous cranial bone flaps: should bone biopsies or swabs be performed?
verfasst von
Ivan P. Bhaskar
Timothy J. J. Inglis
Jacintha Bowman
Gabriel Y. F. Lee
Publikationsdatum
01.02.2013
Verlag
Springer Vienna
Erschienen in
Acta Neurochirurgica / Ausgabe 2/2013
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-012-1517-8

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