title: Experience with a bone bank operation and allograft bone infection in recipients at a medical centre in southern Taiwan.
abstract: To assess the contamination rate of allograft bones at retrieval and the infection rate of the implanted allograft bone, we audited a bone bank retrospectively and reviewed the medical charts of allograft bone recipients between June 1999 and June 2000 at a medical centre in southern Taiwan. The bone bank did its utmost to minimize allograft contamination with hospital-acquired pathogens by adopting purposefully designed criteria for selection of donors. This protocol included sterilization with soaking of the retrieved allograft in a solution of a first-generation cephalosporin before storage and prophylaxis in recipients with first-generation cephalosporin. The contamination rates at allograft retrieval from living and cadaveric donors were 2.7% and 12.4%, respectively (P<0.001). Culture of 262 specimens taken at allograft implant revealed 12 (4.6%) positive for culture. Of the 12 patients implanted with allograft bones positive for culture, nine (75.0%) had allograft bone infection, while three (25.0%) did not. Among the 250 recipients with sterile allograft bones, four (1.6%) were found to have allograft infection. None of the cases of infection required removal of the allograft bones, and all cases were successfully treated with tailored antimicrobial therapy based on susceptibility tests on isolated bacteria. The overall infection rate was 5.0%, which compared favourably with those in other series. A prospective cohort study is needed to determine which of the varied sterilization methodologies gives the best and/or most cost-effective outcome.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung, Taiwan, Republic of China. 88b0@adm.cgmh.com.tw
authors.forename: J W
authors.initials: JW
authors.lastname: Liu
authors.forename: L H
authors.initials: LH
authors.lastname: Chao
authors.forename: L H
authors.initials: LH
authors.lastname: Su
authors.forename: J W
authors.initials: JW
authors.lastname: Wang
authors.forename: C J
authors.initials: CJ
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D018586:Bone Banks; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013242:Sterilization / Q000379:methods; D013624:Taiwan / Q000453:epidemiology; D014184:Transplantation, Homologous
chemical_list: D000900:Anti-Bacterial Agents