title: Intraoperative culture positive allograft bone and subsequent postoperative infections: a retrospective review.
abstract: BACKGROUND
  Obtaining intraoperative cultures of allograft bone just before use in orthopedic procedures is standard practice in many centres; however, the association between positive cultures and subsequent surgical infections is unknown. Our study had 3 goals: to determine the prevalence of positive intraoperative allograft culture and subsequent infection; to determine if, in cases of subsequent infection, organisms isolated at reoperation were the same as those cultured from the allograft at the time of the index procedure; and to assess the costs associated with performing intraoperative allograft cultures.
  
  
  METHODS
  In this retrospective case series, we obtained data on patients receiving allograft bone between 2009 and 2012. Patients receiving allograft with positive cultures were reviewed to identify cases of significant infection. Organisms isolated at reoperation were compared with the allograft culture taken at the time of implantation, and we performed a cost assessment.
  
  
  RESULTS
  Of the 996 allograft bone grafts used, 43 (4.3%) had positive intraoperative cultures and significant postoperative infections developed in 2, requiring reoperation. Antibiotics based on culture results were prescribed in 24% of cases. Organisms cultured at the time of reoperation differed from those isolated initially. The cost of performing 996 allograft cultures was $169 320.
  
  
  CONCLUSIONS
  This series suggests that rates of positive intraoperative bone allograft culture are low, and subsequent infection is rare. In cases of postoperative infection, primary allograft culture and secondary tissue cultures isolated different organisms. Costs associated with performing cultures are high. Eliminating initial culture testing could save $42 500 per year in our health region.
authors.affiliation: From the Division of Orthopaedics, Department of Surgery, University of Saskatchewan, Saskatoon, Sask.
authors.forename: Laura
authors.initials: L
authors.lastname: Sims
authors.affiliation: From the Division of Orthopaedics, Department of Surgery, University of Saskatchewan, Saskatoon, Sask.
authors.forename: Paul
authors.initials: P
authors.lastname: Kulyk
authors.affiliation: From the Division of Orthopaedics, Department of Surgery, University of Saskatchewan, Saskatoon, Sask.
authors.forename: Allan
authors.initials: A
authors.lastname: Woo
mesh_terms: D064591:Allografts / Q000191:economics / Q000382:microbiology* / Q000706:statistics & numerical data; D016025:Bone Transplantation / Q000009:adverse effects / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D015995:Prevalence; D012086:Reoperation / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000382:microbiology*