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Microbial contamination assessment of cryostored autogenous cranial bone flaps: should bone biopsies or swabs be performed?

  • Experimental Research
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Abstract

Background

Autogenous cranioplasty infection requiring bone flap removal is under-recognised as a major complication causing significant morbidity. Microbial contamination of stored bone flaps may be a significant contributing factor. Current infection control practices and storage procedures vary. It is not known whether ‘superficial’ swabs or bone cultures provide a more accurate assessment.

Method

Twenty-five skull flaps that were cryo-stored for more than 6 months were studied. Two swab samples (superficial and deep) and a bone biopsy sample were taken from each skull flap sample and cultured. Half blood agar and half chocolate agar plates were inoculated with the swabs for anaerobic and aerobic cultures respectively. The bone biopsy samples were cultured in brain-heart broth and subcultured similar to the swabs for 5 days.

Results

Incidence of microbial contamination was 20 % in the bone flaps studied. One swab culture and five bone biopsy cultures were positive for bacterial growth, all of which contained Propionibacterium acnes (p = 0.014). Positive cultures were from bone flaps stored less than 18 months, whereas no growth was obtained from bone flaps that were stored longer (p = 0.014).

Conclusions

Bone biopsy culture is a more sensitive technique of assessing microbial contamination of cryo-stored autogenous bone flaps than swab cultures. The clinical implications of in vitro demonstration of microbial contamination require further study.

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Acknowledgements

We thank the staff of the Bacteriology Laboratory, Division of Microbiology & Infectious Diseases, PathWest Laboratory Medicine WA, for their work on the clinical samples and subsequent bacterial identification procedures. We thank the Bart Jones Memorial Fund for funding this study.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, 6009, Australia

    Ivan P. Bhaskar & Gabriel Y. F. Lee

  2. Division of Microbiology and Infectious Diseases, PathWest Laboratory Medicine WA, QE II Medical Centre, Hospital Avenue, Nedlands, Western Australia, 6009, Australia

    Timothy J. J. Inglis & Jacintha Bowman

  3. School of Pathology & Laboratory Medicine, Faculty of Medicine & Dentistry, University of Western Australia, QE II Medical Centre, Nedlands, Western Australia, 6009, Australia

    Timothy J. J. Inglis

  4. School of Surgery, Faculty of Medicine & Dentistry, University of Western Australia, QE II Medical Centre, Nedlands, Western Australia, 6009, Australia

    Gabriel Y. F. Lee

  5. Department of Neurological Sciences, St. Vincent’s Public Hospital, Melbourne, Victoria, Australia

    Ivan P. Bhaskar

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  1. Ivan P. Bhaskar
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  2. Timothy J. J. Inglis
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Correspondence to Ivan P. Bhaskar.

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Bhaskar, I.P., Inglis, T.J.J., Bowman, J. et al. Microbial contamination assessment of cryostored autogenous cranial bone flaps: should bone biopsies or swabs be performed?. Acta Neurochir 155, 367–371 (2013). https://doi.org/10.1007/s00701-012-1517-8

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  • DOI: https://doi.org/10.1007/s00701-012-1517-8

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