Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.190063
Jornal Vascular Brasileiro
Original Article

Existe concordância entre as culturas de osso e tendão em pacientes com lesões profundas de extremidades?

Is there concordance between bone and tendon cultures in patients with foot tissue loss?

Vanessa Prado dos Santos; Carlos Alberto Silveira Alves; André Brito Queiroz; Maria Goreth Matos de Andrade Barberino; Ronald José Ribeiro Fidelis; Cícero Fidelis; José Siqueira de Araújo Filho

Downloads: 0
Views: 53

Resumo

Resumo: Contexto: As infecções profundas de extremidades representam um desafio para o salvamento de membro dos pacientes.

Objetivos: Investigar se existe concordância entre as culturas de osso e tecido profundo em pacientes com lesões tróficas de extremidades.

Métodos: Foi realizado um estudo retrospectivo incluindo 54 pacientes com lesões tróficas profundas de extremidades internados, no Complexo Hospitalar Universitário Professor Edgard Santos, Salvador (BA), Brasil. Foram incluídos todos os pacientes que realizaram culturas de lesões tróficas profundas, com duas modalidades de coleta de exame: osso e fragmentos de tendão profundo. Analisaram-se a concordância, o número total de microrganismos e o número de microrganismos de acordo com a coloração de Gram em ambas as amostras.

Resultados: Entre os 54 doentes incluídos na amostra, a média de idade foi de 63,6 anos, 80% apresentavam DAOP, 70% eram diabéticos, e 72% hipertensos. Estudando as culturas dos 54 pacientes, 28 amostras (52%) foram completamente concordantes, sendo cultivados os mesmos microrganismos nos fragmentos de tendão profundo e de osso. Houve discordância parcial em 13 amostras (24%), e discordância total em 13 (24%). Observou-se que cresceu em média 1,62 microrganismo nos fragmentos de tendão profundo, e 1,72 nas amostras de osso. Analisando separadamente os microrganismos gram-positivos, a média de espécies cultivadas foi de 0,48 em tendão e de 0,44 em tecido ósseo. Por outro lado, para os microrganismos gram-negativos, a média de microrganismos cultivados foi de 1,14 e 1,27 nas amostras de tendão e de osso, respectivamente.

Conclusões: Cerca de metade dos pacientes portadores de lesões tróficas profundas de extremidades apresentaram concordância total entre as culturas de osso e de tendão.

Palavras-chave

análise microbiológica, infecção de feridas, pé diabético

Abstract

Abstract: Background: Deep infections of the extremities are a challenge that threaten limb salvage.

Objective: To investigate whether the results of bone and deep tissue cultures from patients with trophic limb ulcers coincide.

Methods: A retrospective study was conducted with data from 54 patients with deep trophic limb ulcers admitted to the Complexo Hospitalar Universitário Professor Edgard Santos, Salvador (BA), Brazil. The study analyzed all patients for whom cultures of material from foot wounds in patients with tissue loss had been performed using two specimen types: bone and fragments of deep tendon. The study analyzed concordance between the two sample types and total number of microorganisms and numbers of microorganisms by Gram staining in both samples.

Results: The mean age of the 54 patients in the sample was 63.6 years, 80% had PAOD, 70% were diabetic, and 72% were hypertensive. Analysis of the cultures showed that 28 (52%) pairs of samples from the 54 patients exhibited complete concordance, with the same microorganisms grown from fragments of deep tendon and bone. There was partial disagreement in 13 samples (24%) and total disagreement in 13 (24%). On average, 1.62 microorganisms were isolated from deep tendon fragments and 1.72 were isolated from bone samples. Analyzing Gram-positive microorganisms separately, the mean number of species grown was 0.48 for tendon cultures and 0.44 for bone cultures. In contrast, the mean number of Gram-negative microorganisms isolated was 1.14 for tendon samples and 1.27 for bone samples.

Conclusions: Around half of the patients with foot tissue loss had bone and tendon cultures that coincided exactly.
 

Keywords

microbiological analysis, wound infections, diabetic foot

References

Brasil. Ministério da Saúde. Diabetes mellitus como problema de saúde pública. In: Brasil. Ministério da Saúde. Manual de diabetes. 2ª ed. Brasília: Ministério da Saúde; 1993. 92 p.

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45(1, Suppl S):S5-67. http://dx.doi.org/10.1016/j.jvs.2006.12.037. PMid:17223489.

Mills JL Sr, Conte MS, Armstrong DG, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI). J Vasc Surg. 2014;59(1):220-234.e2, 2. http://dx.doi.org/10.1016/j.jvs.2013.08.003. PMid:24126108.

Calle-Pascual AL, Garcia-Torre N, Moraga I, et al. Epidemiology of nontraumatic lower- extremity amputation in Area 7, Madrid, between 1989 and 1999: a population-based study. Diabetes Care. 2001;24(9):1689-93. http://dx.doi.org/10.2337/diacare.24.9.1686. PMid:11522722.

Armstrong DG, Lavery LA, Harkless LB. Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care. 1998;21(5):855-9. http://dx.doi.org/10.2337/diacare.21.5.855. PMid:9589255.

Lima A, Santos A, Fidelis C, et al. Diretrizes brasileiras para o tratamento das infecções em úlceras neuropáticas dos membros inferiores. Braz J Infect Dis. 2010;14(Suppl 1):1-76.

Lipsky BA, Berendt AR, Cornia PB, et al. 2012 infectious disease society of america clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):132-73. http://dx.doi.org/10.1093/cid/cis346.

Crouzet J, Lavigne JP, Richard JL, Sotto A. Diabetic foot infection: a critical review of recent randomized clinical trials on antibiotic therapy. Int J Infect Dis. 2011;15(9):e601-10. http://dx.doi.org/10.1016/j.ijid.2011.05.003. PMid:21737333.

Sharp CS, Bessmen AN, Wagner FW Jr, Garland D, Reece E. Microbiology of superficial and deep tissues in infected diabetic gangrene. Surg Gynecol Obstet. 1979;149(2):217-9. PMid:462355.

Kessler L, Piemont Y, Ortega F, et al. Comparison of microbiological results of needle puncture vs. superficial swab in infected diabetic foot ulcer with osteomyelitis. Diabet Med. 2006;23(1):99-102. http://dx.doi.org/10.1111/j.1464-5491.2005.01764.x. PMid:16409574.

Caputo GM, Cavanagh PR, Ulbrecht JS, Gibbons GW, Karchmer AW. Assessment and management of foot disease in patients with diabetes. N Engl J Med. 1994;331(13):854-60. http://dx.doi.org/10.1056/NEJM199409293311307. PMid:7848417.

Senneville E, Melliez H, Beltrand E, et al. Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis. 2006;42(1):57-62. http://dx.doi.org/10.1086/498112. PMid:16323092.

Senneville E, Morant H, Descamps D, et al. Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot. Clin Infect Dis. 2009;48(7):888-93. http://dx.doi.org/10.1086/597263. PMid:19228109.

Uçkay I, Gariani K, Pataky Z, Lipsky BA. Diabetic foot infections: state-of-the-art. Diabetes Obes Metab. 2014;16(4):305-16. http://dx.doi.org/10.1111/dom.12190. PMid:23911085.

Carvalho CB, Neto RM, Aragão LP, Oliveira MM, Nogueira MB, Forti AC. Diabetic foot infection. Bacteriologic analysis of 141 patients. Arq Bras Endocrinol Metabol. 2004;48(3):398-405. http://dx.doi.org/10.1590/S0004-27302004000300012. PMid:15640905.

Cardoso NA, Cisneros LL, Machado CJ, Procópio RJ, Navarro TP. Fatores de risco para mortalidade em pacientes submetidos a amputações maiores por pé diabético infectado. J Vasc Bras. 2018;17(4):296-302. http://dx.doi.org/10.1590/1677-5449.010717. PMid:30787947.
 

5dcb10b90e8825920403b87a jvb Articles

J Vasc Bras

Share this page
Page Sections