Lack of microbiological concordance between bone and non-bone specimens in chronic osteomyelitis: an observational study.
BACKGROUND
Prognosis of chronic osteomyelitis depends heavily on proper identification and treatment of the bone-infecting organism. Current knowledge on selecting the best specimen for culture is confusing, and many consider that non-bone specimens are suitable to replace bone cultures. This paper compares the microbiology of non-bone specimens with bone cultures, taking the last as the diagnostic gold standard.


METHODS
Retrospective observational analysis of 50 patients with bacterial chronic osteomyelitis in a 750-bed University-based hospital.


RESULTS
Concordance between both specimens for all etiologic agents was 28%, for Staphylococcus aureus 38%, and for organisms other than S. aureus 19%. The culture of non-bone specimens to identify the causative organisms in chronic osteomyelitis produced 52% false negatives and 36% false positives when compared against bone cultures.


CONCLUSIONS
Diagnosis and therapy of chronic osteomyelitis cannot be guided by cultures of non-bone specimens because their microbiology is substantially different to the microbiology of the bone.
Zuluaga
Andrés F
AF
Section of Infectious Diseases, Department of Medicine, University of Antioquia Medical School and Hospital Universitario San Vicente de Paul, Medellín, Colombia. azuluaga@medicina.udea.edu.co
Galvis
Wilson
W
Jaimes
Fabián
F
Vesga
Omar
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001842:Bone and Bones / Q000382:microbiology* / Q000473:pathology; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000302:isolation & purification