Infection not associated with use of human musculoskeletal tissue allografts
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Infection not associated with use of human musculoskeletal tissue allografts Robert K. Eastlack • Thomas J. Kesman Robin Patel • Paul M. Huddleston
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Received: 18 December 2008 / Accepted: 7 September 2010 / Published online: 29 September 2010 Ó Springer Science+Business Media B.V. 2010
Abstract 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 R. K. Eastlack T. J. Kesman P. M. Huddleston (&) Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA e-mail: [email protected] R. Patel Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA R. Patel Division of Clinical Microbiology, Mayo Clinic, Rochester, MN, USA Present Address: R. K. Eastlack Division of Orthopedic Surgery, Scripps Clinic, La Jolla, CA, USA
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. Keywords Allograft Clostridium Postoperative infection Tissue bank Abbreviations AATB American Association of Tissue Banks CDC Centers for Disease Control and Prevention
Introduction Advancements in surgical procedures have led to a substantial increase in demand for musculoskeletal allograft tissue, but infections attributable to such tissue are rare. The deaths of 3 healthy individuals after use of musculoskeletal allografts during arthroscopic knee surgery resulted in substantial concern about the safety of musculoskeletal allograft tissue and prompted a large-scale investigation by the Centers for Disease Control and Prevention (CDC) (2001). The pathogen responsible for that tragedy was Clostridium sordellii. On the basis of their
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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 (Malinin et al. 2003; Ibrahim et al. 2004). Further evaluation by Kainer et al. (2004) in 2004 showed deficiencies in processing an
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