Abstract
We have carried out a study on the behaviour pattern of implanted allografts initially stored in perfect conditions (aseptically processed, culture-negative and stored at −80 °C) but which presented positive cultures at the implantation stage. There is no information available on how to deal with this type of situation, so our aim was to set guidelines on the course of action which would be required in such a case. This was a retrospective study of 112 patients who underwent a spinal arthrodesis and in whom a total of 189 allograft pieces were used. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV (via PCR techniques) were negative. The allografts were stored by freezing them at −80 °C. A sample of the allograft was taken for culture in the operating theatre just before its implantation in all cases. The results of the cultures were obtained 3–5 days after the operation. There were 22 allografts with positive culture results (12%) after implantation. These allografts were implanted in 16 patients (14%). Cultures were positive for staphylococci coagulase negative (ECN) in 10 grafts (46%), Pseudomonas stutzeri in two grafts (9%), Corynebacterium jeikeium in two grafts (9%), staphylococci coagulase positive in two grafts (9%) and for each of the following organisms in one case each (4%): Corynebacterium spp., Actinomyces odontolyticus, Streptococcus mitis, Peptostreptococcus spp., Rhodococcus equi and Bacillus spp. No clinical infection was seen in any of these patients. Positive cultures could be caused by non-detected contamination at harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment different from our antibiotic protocol is required in the case of positive culture results of a graft piece after implantation.
Similar content being viewed by others
References
Amillo S, Buzón L, De la Concepción M, Castro J, González A, López-Duran L, et al (1992) Homoinjertos osteotendinosos: recomendaciones en su manipulación. Rev Esp Transp 1:251–255
Barrios RH, Leyes M, Amillo S, Oteiza C (1994) Bacterial contamination of allografts. Acta Orthop Belg 60:152–154
Beguiristáin JL, Villas C, Preite R, Martínez R, Barrios RH (1997) Lumbosacral arthrodesis using pedicular screws and ringed rods. Eur Spine J 6:233–238
Centers for Disease Control and Prevention (2002)Update: allograft-associated bacterial infections in USA. MMWR 51:207–210
Czitrom AA, Winkler H (1996) Orthopaedic allograft surgery. Springer, Berlin Heidelberg New York
Davis N, Curry A, Gambhir K, Panigrahi H, Walker CR, Wilkins EG, et al (1999). Intraoperative bacterial contamination in operations for joint replacement. J Bone Joint Surg Br 81:886–889
EAMST (1997) Common standards for musculoskeletal tissue banking. EAMST, Vienna
Ehrler DM, Vaccaro AR (2000). The use of allograft bone in lumbar spine surgery. Clin Orthop 371:38–45
Friedlander GE, Mankin HJ, Sell KW (1983) Osteochondral allografts: biology, banking, and clinical applications. Little Brown, Boston
Grogan DP, Kalen V, Ross Guidera KJ, Pugh LI (1999) Use of allograft bone for posterior spinal fusion in idiopathic scoliosis. Clin Orthop 369:273–278
Ivory JP, Thomas IH (1993) Audit of a bone bank. J Bone Joint Surg Br 75:355–357
Li CM, Ho YR, Liu YC (2001). Transmission of human immunodeficiency virus through bone transplantation: a case report. J Formos Med Assoc 100:350–351
Ortiz Cruz EJ, Campo Loarte J, Martínez Martín J, et al (2000) Estructura y organización de un banco de huesos y tejidos. Rev Ortop Traumatol 45:127–138
Oteiza Urbanell C, Leyes Vence M, Leiva León J, et al (1994) Estudio comparativo de distintos métodos para la detección de contaminación bacteriana en aloinjertos óseos. Rev Ortop Traumatol 39:502–504
Veen MR, Bloem RM, Petit PL (1994). Sensitivity and negative predictive value of swab cultures in musculoskeletal allograft procurement. Clin Orthop 300:259–263
Segur Vilalta JM, Suso Vergara S, García Ramiro S, et al (1997) Factores de contaminación de los aloinjertos óseos. Rev Ortop Traumatol 41:584–587
Smith RA, Ingels J, Lochemes JJ, Dutkowsky JP, Pifer LL(2001) Gamma irradiation of HIV-1. J Orthop Res19:815–819
Suso Vergara S (2002). Monografías SECOT: Banco de huesos. Masson, Barcelona
Tomford WW, Thongphasuk J, Mankin HJ, Ferraro MJ (1990) Frozen musculoskeletal allografts: a study of the clinical incidence and causes of infection associated with their use. J Bone Joint Surg Am 72:1137–1143
Tomford WW (1995) Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg Am 77:1742–1754
Villas C, Beguiristáin JL, Mora G, Calvo R, Valdés G (1996) Aloinjertos en artrodesis vertebrales extensas. Rev Med Univ Navarre 40:15–19
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Barriga, A., Díaz-de-Rada, P., Barroso, J.L. et al. Frozen cancellous bone allografts: positive cultures of implanted grafts in posterior fusions of the spine. Eur Spine J 13, 152–156 (2004). https://doi.org/10.1007/s00586-003-0633-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-003-0633-9