Vol 43 # 2 June 2011 - Kma.org.kw

June 2011
KUWAIT MEDICAL JOURNAL 125
Original Article
The Diagnostic Value of Sinus-Track Cultures in
Secondary Pediatric Chronic Osteomyelitis
Mehmet Ulug 1 , Celal Ayaz 2 , Mustafa Kemal Celen 2 , Serdar Necmioglu 3
1
Department of Infectious Diseases and Clinical Microbiology, Özel Ümit Hospital, Eskişehir, Turkey
2
Department of Infectious Diseases and Clinical Microbiology, Dicle University Medical School, Diyarbakir, Turkey
3
Department of Orthopedics and Traumatology, Diyarbakir, Turkey
Kuwait Medical Journal 2011; 43 (2): 125-129
ABSTRACT
Objective: To determine and compare the diagnostic value
and accuracy of culture of material from a sinus track with
culture of material from bone specimens
Design: Retrospective study
Setting: Dicle University Medical School and Batman State
Hospital, Turkey
Subjects: Twenty-one patients with secondary chronic
osteomyelitis (COM). Material for culture was taken from
the sinus as well as the bone specimens
Interventions: Surgery for COM
Main outcome measures: The diagnostic value of sinus track
culture
Results: The mean age of patients was 8.5 ± 3.8 years. 15
(71.4%) were male and six (28.6%) were female. Organisms
isolated from bone cultures were Staphylococcus 71.4% (15 /
21), Pseudomonas aeruginosa 9.5% (2 / 21), Escherichia coli 9.5%
(2 / 21), Proteus mirabilis 4.8% (1 / 21), Klebsiella pneumoniae
4.8% (1 / 21), respectively. Cultures of sinus track material
and bone specimens gave identical results in 47.6% of
patients.
Conclusion: This study shows that if treatment of COM was
planned according to the microbiological analysis of material
from the sinus-track, it may not result in recovery every
time. We found approximately 48% concordance between
sinus-track and bone cultures. In other words, antimicrobial
therapy guided by antibiograms of bacteria isolated from
sinus-track would be inappropriate in 52% of patients with
COM and result in treatment failure.
KEY WORDS: bacteriology, childhood, chronic osteomyelitis, sinus-track
INTRODUCTION
Osteomyelitis is an inflammatory process
accompanied by bone destruction and caused by an
infecting microorganism. The infection can be limited
to a single portion of the bone or can involve several
regions, such as marrow, cortex, periosteum, and the
surrounding soft tissue [1] . It can be caused by bacteria,
fungi and a variety of other organisms. Among the
pathogenic microorganisms Staphylococcus aureus is
by far the most commonly involved in all age groups,
including newborns. Group A Streptococcus is next
in frequency but constitutes fewer than 10% of all
cases [2] .
Osteomyelitis in pediatric patients occurs uniquely
because of the blood supply, which may be compromised
by trauma [3] . Chronic osteomyelitis (COM) can be
primary, when it arises from failed treatment of acute
hematogenous osteomyelitis (AHO) or secondary,
when it is caused by trauma to the bone, open fractures
or from postoperative infection [4] . The hallmark of
COM is bone necrosis and, as opposed to AHO in
which medical treatment results in > 90% cures, COM
often requires multiple surgical procedures and long
term antibiotics [5] .
The most important step in COM is to isolate
the offending organisms so that the appropriate
antimicrobial therapy can be chosen [6] . In cases
of COM, sinus-tracks frequently develop from
infected bone to the skin. Several investigators have
used cultures of specimens from sinus-tracks to
identify the pathogens [7, 8] . In doing so, they have
assumed that bacterial cultures from the sinus-track
originate from bone infection itself. Material taken
from an open sinus-track by swabbing will give
misleading results because the isolates may include
non-pathogenic microorganisms that are colonizing
the site. The aim of this study was to retrospectively
compare the diagnostic value of the sinus-track
and bone specimen cultures in secondary pediatric
COM.
Address correspondence to:
Dr. Mehmet Ulug, MD, Özel Ümit Hospital, Department of Infectious Diseases and Clinic Microbiology, 26140 Eskişehir, Turkey. Tel: 05324475756,
Fax: +902223350170, E-mail: mehmetulug21@yahoo.com