Laboratory Contamination Affecting Orthopedic Surgical Management

Dowen, Daniel; Jeavons, Richard; Michla, Yusuf; Berrington, Andrew; Green, Stephen

doi:10.1016/j.arth.2010.12.025

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…In addition, the elevated risk of sample contamination with microbiological cultures is a well-recognized phenomenon. 23,24 These limitations highlight the need for more precise and quantitative assays such as NGS. 25 NGS leverages massive parallel DNA replication technology, cross-referenced with a known DNA marker database allowing for a rapid, yet precise, identification of nucleic acid at a more cost-effective margin when compared with standard sequencing.…”

Section: Discussionmentioning

confidence: 99%

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Using Next-Generation Sequencing to Understand Infection Prevention in Surgical Treatment of Upper Extremity Fractures—A Prospective Cohort Study

Dehghani,

DeAngelis,

Hallman

et al. 2024

J Am Acad Orthop Surg

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Introduction: Postoperative fracture site infection can lead to notable patient morbidity, increase cost of care, and further contribute to healthcare disparities globally. Dogma suggests surgical blades as a vehicle for introducing bacteria into the surgical site; however, there is a paucity of literature to support this claim. This study uses advanced DNA sequencing to detect bacterial DNA on surgical blades used in upper extremity fracture surgeries. Methods: This was a prospective study, conducted at a high-volume level 1 trauma center. All acute, closed upper extremity fractures requiring surgical stabilization were consecutively enrolled in a prospective fashion. The primary end point was the presence of bacterial DNA on the surgical blade using next-generation sequencing (NGS). At the time of surgery, two blades were sterilely opened. One blade served as the control while the other was used for the initial skin incision. Two negative control blades were opened directly into a sterile container. Two positive control blades were used for skin incision through known infections. All samples were sent for NGS analysis. Results: Forty patients were enrolled in this study. The median age was 33.5 years, and 30% were female; the median body mass index was 26.52. Humerus fractures were the most common injury (N = 17, 42.5%), followed by clavicle fractures (13, 32.5%) and radius/ulna fractures (10, 25.0%). NGS analysis revealed no contamination of test blades used for skin incision. Three control blades tested positive for bacterial DNA. Negative control blades tested negative for bacterial DNA (0/2); the positive control blades resulted positive for bacterial DNA contamination (2/2). Conclusion: Surgical blades used for skin incision in the upper extremity are not contaminated with bacterial DNA as analyzed by NGS. This finding challenges previous surgical dogma regarding surgical blade contamination and supports that the same surgical blade can safely be used for deeper dissection. Level of evidence: Level II study: IRB approval—IRB#848938.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Using Next-Generation Sequencing to Understand Infection Prevention in Surgical Treatment of Upper Extremity Fractures—A Prospective Cohort Study

Dehghani,

DeAngelis,

Hallman

et al. 2024

J Am Acad Orthop Surg

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“…Similarly, it may present challenges to the histology laboratory to handle shared specimens with the microbiology laboratory under sterile conditions; this could lead to contaminants being introduced to the specimen, which when collected from normally sterile sites during surgery, has great potential to result in the misdiagnosis of an infectious process and prolonged, unnecessary antimicrobial therapies. 25 Intraoperative consultation between the surgeon and pathologist is exceedingly beneficial to confirming both groups are aware of the clinical circumstances, of the questions being asked, and how the specimen should be processed to provide all the necessary components to arrive at a comprehensive diagnosis.…”

Section: Other Preanalytic Considerations Andmentioning

confidence: 99%

How the Pathologist Can Help the Surgeon Collect Better Specimens for Microbiology Culture

Stempak

Middleton

Navalkele

et al. 2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Specimen quality is paramount for microbiology culture in order to ensure the testing is performed appropriately and the results, generated accurately, reflect the patient's clinical situation and guide proper treatment. Several factors play a critical role in guaranteeing the accuracy of the culture results, including adequate specimen collection by the surgeon, proper labeling, and timely transport to the laboratory. Objective.— To educate pathologists, surgeons, and other medical personnel involved in the collection and processing of surgical specimens submitted for microbiologic culture. To assure the pathogen is correctly identified, proper protocols must be followed. The accurate identification of the infectious microorganisms from surgical specimens is vital for the treating clinician to ensure the correct antimicrobial therapy is administered. Data Sources.— An analysis of relevant literature was performed by using PubMed. Articles were selected on the basis of their relevance to the topic as well as their date of publication. Articles published between 2000 and 2018 were deemed sufficient for inclusion, while older references, regardless of relevance, were excluded. Conclusions.— The process of properly obtaining specimens for microbiology culture from the operating room is a complex process that requires collaboration between the collecting surgeon and the pathologist and microbiology laboratory in order to provide the highest quality of results from which important treatment decisions are then implemented. Engaging leadership to develop mutually agreed-upon institutional best practices will help not only to standardize practices but also to improve the quality of microbiology results reported.

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“…Early recognition of pseudo-outbreaks is as important as early recognition of outbreaks, as it prevents unnecessary and incorrect treatment of patients (1). This pseudo-outbreak also highlights the role of the clinical microbiologist, in that correlation with clinical information and histological information is important when facing unusual culture results.…”

mentioning

confidence: 99%

“…aboratory contamination of clinical specimens can lead to erroneous microbiology reports which can adversely affect patient management (1). Early recognition of such pseudo-outbreaks is important for clinical microbiology laboratories.…”

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confidence: 99%

Characterization of a Tsukamurella Pseudo-Outbreak by Phenotypic Tests, 16S rRNA Sequencing, Pulsed-Field Gel Electrophoresis, and Metabolic Footprinting

Fung

Teng

et al. 2013

J Clin Microbiol

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We report a pseudo-outbreak of Tsukamurella due to improperly wrapped scissors used for processing of tissue specimens. A polyphasic approach, involving biochemical, genetic, and metabolomic techniques, was used in the laboratory investigation. This report highlights that early recognition of pseudo-outbreaks is important in preventing unnecessary and incorrect treatment of patients. Laboratory contamination of clinical specimens can lead to erroneous microbiology reports which can adversely affect patient management (1). Early recognition of such pseudo-outbreaks is important for clinical microbiology laboratories. In 2010, five isolates of Tsukamurella were isolated from the tissue specimens of four patients within 10 days in our clinical microbiology laboratory. Outbreak investigation revealed that the recovery of Tsukamurella was due to laboratory contamination during processing of the tissue samples. In this article, we report the investigation of this pseudo-outbreak and characterization of the outbreak strains using a polyphasic approach.The index patient was a 28-year-old female veterinarian, admitted for fever of unknown origin with right axillary lymphadenopathy (Table 1, patient 1). A direct Gram smear of the right axillary lymph node biopsy specimen in our laboratory revealed Gram-positive bacilli. A lymph node biopsy specimen was culture positive for Tsukamurella. However, the histological section, processed by the pathology laboratory, showed coalescent epithelioid cell granulomas, and no organisms were revealed by Gram staining, Ziehl-Neelsen staining, periodic acid-Schiff diastase staining, or Grocott staining. Bartonella henselae serology showed a Ͼ4-fold rise in IgG level for sera collected 6 days apart. PCR amplification and sequencing for the 16S rRNA gene of B. henselae was also positive on the right axillary lymph node. Since the clinical syndrome was compatible with cat scratch disease, there was a suspicion of contamination of the lymph node biopsy specimen. Contamination at the level of specimen processing in the microbiology laboratory was suspected because it was seen in the direct Gram smear that was processed in the microbiology laboratory but not in the biopsy specimens processed in the pathology laboratory.Within a period of 9 days, 4 additional tissue specimens from 3 patients also grew Tsukamurella. A direct Gram smear of these 4 specimens performed in the clinical microbiology laboratory was negative. Line listing was performed for the 4 cases as described previously (Table 1) (2). A review of our laboratory records revealed that in the 24-month period before the outbreak, only 3

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Laboratory Contamination Affecting Orthopedic Surgical Management

Cited by 5 publications

References 6 publications

Using Next-Generation Sequencing to Understand Infection Prevention in Surgical Treatment of Upper Extremity Fractures—A Prospective Cohort Study

Using Next-Generation Sequencing to Understand Infection Prevention in Surgical Treatment of Upper Extremity Fractures—A Prospective Cohort Study

How the Pathologist Can Help the Surgeon Collect Better Specimens for Microbiology Culture

Characterization of a Tsukamurella Pseudo-Outbreak by Phenotypic Tests, 16S rRNA Sequencing, Pulsed-Field Gel Electrophoresis, and Metabolic Footprinting

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