title: Section's osseous slice biopsy during major amputation of lower extremity: preliminary results of prospective cohort study.
abstract: BACKGROUND
  The purpose of this cohort study was to assess the incidence of positive cultures in section's osseous slice biopsy (SOB) taken at the level of major limb amputation. In case of positive cultures we sought whether the microorganisms present in SOB could take origin from the primary infection site necessitating the amputation. The impact of diabetes on culture results was also investigated.
  
  
  METHODS
  This prospective cohort study, which aimed to confirm the results of the pilot study, analysed patients who underwent major limb amputation between 2012 and 2013 in three Lithuanian hospitals. SOBs at the amputation site (surgical bone biopsies) and percutaneous bone biopsies of the distal site were performed simultaneously during limb amputation. Tissue cultures were analysed by microbiologists, and species along with antibiograms were reported. Histopathological assessment and bacterial typing were also evaluated. A positive culture was defined as the identification of at least 1 bacteria not belonging to the skin flora, at least 2 bacteria belonging to the skin flora with the same antibiotic susceptibility profiles or the same bacteria belonging to the skin flora in two different sites. Fisher's exact test and Student's test were used to compare the populations and the microbiological results. The statistical significance level was set at P < 0.05.
  
  
  RESULTS
  Sixty-nine patients (35 males/34 females), mean age 68.7 (S = 13.6) years, including 21 (30.4%) with diabetes underwent the major limb amputation. Forty-five amputations (65.2%) were done above the knee. In total, 207 SOBs and 207 percutaneous distal site biopsies were studied. SOB cultures were positive in 11 (15.9%) cases. In 5 (45.5%) cases the same microorganisms were identified in both SOB and distal biopsy cultures. No association between culture results and presence of diabetes was identified.
  
  
  CONCLUSIONS
  Our results suggest that, independently of the diabetes status, foot infection may silently spread along the bone and can achieve the site of major limb amputation. Additional investigations aiming to confirm this hypothesis and to evaluate a prognostic value are in progress.
authors.affiliation: Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania. danguole.simanaityte@gmail.com.
authors.forename: Danguole
authors.initials: D
authors.lastname: Vaznaisiene
authors.affiliation: Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania. rita.sulcaite@gmail.com.
authors.forename: Rita
authors.initials: R
authors.lastname: Sulcaite
authors.affiliation: Department of Laboratory Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania. astravitka@hotmail.com.
authors.forename: Astra
authors.initials: A
authors.lastname: Vitkauskiene
authors.affiliation: Department of Surgical Infection, Republican Hospital of Kaunas, Kaunas, Lithuania. spucis.arturas@gmail.com.
authors.forename: Arturas
authors.initials: A
authors.lastname: Spucis
authors.affiliation: Department of Surgical Infection, Republican Hospital of Kaunas, Kaunas, Lithuania. areingardas@yahoo.com.
authors.forename: Anatolijus
authors.initials: A
authors.lastname: Reingardas
authors.affiliation: Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania. vytautas.kymantas@gmail.com.
authors.forename: Vytautas
authors.initials: V
authors.lastname: Kymantas
authors.affiliation: Department of Surgery, Kaunas Clinical Hospital, Kaunas, Lithuania. kebalana@gmail.com.
authors.forename: Kestutis
authors.initials: K
authors.lastname: Balanaska
authors.affiliation: Department of Surgery, Kaunas Clinical Hospital, Kaunas, Lithuania. rolandas.sleivys@gmail.com.
authors.forename: Rolandas
authors.initials: R
authors.lastname: Sleivys
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania. lvelicka@gmail.com.
authors.forename: Linas
authors.initials: L
authors.lastname: Velicka
authors.affiliation: Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania. juozasbelickas@gmail.com.
authors.forename: Juozas
authors.initials: J
authors.lastname: Belickas
authors.affiliation: Institute of Anatomy, Lithuanian University of Health Sciences, Kaunas, Lithuania. kristina.rysevaite@gmail.com.
authors.forename: Kristina
authors.initials: K
authors.lastname: Rysevaite-Kyguoliene
authors.affiliation: Institute of Anatomy, Lithuanian University of Health Sciences, Kaunas, Lithuania. dainius.pauza@lsmuni.lt.
authors.forename: Dainius H
authors.initials: DH
authors.lastname: Pauza
authors.affiliation: Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania. amickiene@gmail.com.
authors.forename: Aukse
authors.initials: A
authors.lastname: Mickiene
authors.affiliation: Infectious Diseases Department, Dron Hospital, Tourcoing, France. esenneville@ch-tourcoing.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Senneville
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects*; D001706:Biopsy; D001842:Bone and Bones / Q000382:microbiology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000382:microbiology / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D012867:Skin / Q000382:microbiology