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Medline ® Abstract for Reference 44

of 'Clinical manifestations, diagnosis, and management of diabetic infections of the lower extremities'

Lack of microbiological concordance between bone and non-bone specimens in chronic osteomyelitis: an observational study.
Zuluaga AF, Galvis W, Jaimes F, Vesga O
BMC Infect Dis. 2002;2:8. Epub 2002 May 16.
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.
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