Cadaveric allograft microbiology

Ibrahim, Talal; Stafford, Harry; Esler, Colin; Power, Richard

doi:10.1007/s00264-004-0579-5

Cited by 41 publications

(22 citation statements)

References 12 publications

(16 reference statements)

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“…These rates parallel those in other studies that evaluated contamination rates in living and cadaveric donor musculoskeletal allografts Martinez et al 2003;Vehmeyer et al 1999Vehmeyer et al , 2002. The incidence of Clostridium species contamination of tissue allografts obtained from cadaveric sources has ranged from 1% to 8% Ibrahim et al 2004;Martinez et al 2003), although the clinical significance of this rate is uncertain. Spore-forming organisms such as Clostridium species clearly require special consideration during procurement and processing of allograft tissues.…”

Section: Discussionsupporting

confidence: 61%

“…On the basis of their evaluation, the CDC recommended that physicians consider Clostridium species as a potential cause of infections after allograft use and that antimicrobial treatment should be tailored accordingly. Subsequent studies have shown that contamination with Clostridium species is not unusual in allografts harvested from cadaver donors Ibrahim et al 2004). Further evaluation by Kainer et al (2004) in 2004 showed deficiencies in processing and preparation techniques by a single tissue bank that likely resulted in suspect implantations.…”

Section: Introductionmentioning

confidence: 97%

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Infection not associated with use of human musculoskeletal tissue allografts

et al. 2010

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The deaths of otherwise healthy patients that are attributable to contaminated allografts have heightened concerns about the screening, processing, and use of such tissues. We present one tertiary care institution's experience with musculoskeletal allografts and determine the frequency of postoperative Clostridium infection. We used an institutional microbiology database to identify all records of culture-confirmed Clostridium infection from January 1990 through July 2006. A comprehensive musculoskeletal database was cross-referenced to include all possible allograft samples surgically collected or implanted from January 1990 through July 2004 to determine the frequency of Clostridium infection associated with use of allograft musculoskeletal tissue. Musculoskeletal allografts were implanted in 16,314 patients during the study period. After a minimum follow-up of 2 years, no patient had development of a definite Clostridium infection that was attributable to the use of musculoskeletal allograft tissue. These outcomes can be achieved with established screening and processing techniques for donor tissue.

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 97%

Infection not associated with use of human musculoskeletal tissue allografts

et al. 2010

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“…Concerns, however, exist regarding the efficacy of frozen or freeze dried allograft, the potential of immunogenicity, and the hazard of microbial contamination, though the rate of disease transmission has proven to be low [1,13,24,26,47]. In addition, the use of allograft is associated with considerable expense, and patients' reservations towards allograft implantation may play an important role as well [23].…”

Section: Introductionmentioning

confidence: 99%

A level-1 pilot study to evaluate of ultraporous β-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis

et al. 2008

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The objective of this study is to compare the clinical and radiographic results of ultraporous b-tricalcium phosphate (b-TCP) versus autogenous iliac crest bone graft (ICBG), through prospective randomized pilot study (EBM-Level 1), as graft extenders in scoliosis surgery. In the posterior correction of scoliosis, local bone resected as part of the procedure is used as the base bone graft material. Supplemental grafting from the iliac crest is considered the gold-standard in posterior spinal fusion. However, autograft is not available in unlimited quantities, and bone harvesting is a source of significant morbidity. Ultraporous b-TCP might be a substitute for ICBG in these patients and thus eliminate donor site morbidity. A total of 40 patients with adolescent idiopathic scoliosis (AIS) were randomized into two treatment groups and underwent corrective posterior instrumentation. In 20 patients, ICBG harvesting was performed whereas the other half received b-TCP (VITOSS Ò ) to augment the local bone graft. If thoracoplasty was performed, the resected rib bone was added in both groups. Patients were observed clinically and radiographically for a minimum of 20 months postoperatively, with a mean follow-up of 4 years. Overall pain and pain specific to the back and donor site were assessed using a visual analog scale (VAS). As a result, both groups were comparable with respect to the age at the time of surgery, gender ratio, preoperative deformity, and hence length of instrumentation. There was no significant difference in blood loss and operative time. In nine patients of the b-TCP group and eight patients of the ICBG group, thoracoplasty was performed resulting in a rib graft of on average 7.9 g in both groups. Average curve correction was 61.7% in the b-TCP group and 61.2% in the ICBG group at hospital discharge (P = 0.313) and 57.2 and 54.3%, respectively, at follow-up (P = 0.109). Loss of curve correction amounted on average 2.6°in the b-TCP group and 4.2°in the comparison group (P = 0.033). In the ICBG group, four patients still reported donor site pain of on average 2/10 on the VAS at last follow-up. One patient in the b-TCP group was diagnosed with a pseudarthrosis at the caudal end of the instrumentation. Revision surgery demonstrated solid bone formation directly above the pseudarthrosis with no histological evidence of b-TCP in the biopsy taken. In conclusion, the use of b-TCP instead of ICBG as extenders of local bone graft yielded equivalent results in the posterior correction of AIS. The promising early results of this pilot study support that b-TCP appears to be an effective bone substitute in scoliosis surgery avoiding harvesting of pelvic bone and the associated morbidity.

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“…In most research in which there are both bone and hemoculture samples, the highest bacteria contamination levels are found in the latter (Deijkers et al 1997;Ibrahim et al 2004;Vehmeyer et al 2002). Vehmeyer's findings showed that there was a greater risk of contamination in blood brought about by highly virulent microorganisms such as Staphylococcus spp., Streptococcus spp., and Escherichia coli in those cases in which the donor had died violently (Vehmeyer et al 2002).…”

Section: Discussionmentioning

confidence: 97%

Contamination of tissue allografts from a deceased donor through haematic dissemination: a case study

Garcia

Olmos-García

et al. 2009

Cell Tissue Bank

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Infection is one of the most dangerous complications that can be seen when implanting bone or tendon allografts from a deceased donor. The most common germs isolated are found among the cutaneous florae, but sometimes they may be present in the bloodstream as a result of severe injuries suffered before the time of the decease. We present a case of contamination of allografts in a musculoskeletal tissue donor deceased after an accident, whose allografts were contaminated by gastrointestinal microorganisms, probably disseminated through the donor's blood.

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Cadaveric allograft microbiology

Cited by 41 publications

References 12 publications

Infection not associated with use of human musculoskeletal tissue allografts

Infection not associated with use of human musculoskeletal tissue allografts

A level-1 pilot study to evaluate of ultraporous β-tricalcium phosphate as a graft extender in the posterior correction of adolescent idiopathic scoliosis

Contamination of tissue allografts from a deceased donor through haematic dissemination: a case study

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