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Prevalence and Predictors of Bacterial Contamination in Excisional Lymph Node Biopsies: Implications for Diagnosis and Management.
The American Journal of Surgical Pathology ( IF 5.6 ) Pub Date : 2021-03-17 , DOI: 10.1097/pas.0000000000001699
Christopher B Hergott 1 , Jeffrey W Craig 2 , Jason L Hornick 1 , Olga K Weinberg 3
Affiliation  

Routine tissue handling exposes lymph node specimens to microbial contamination that can confound microbiological culture results and interfere with diagnosis. The scope and impact of this problem remain poorly understood. We combined over 13 years of lymph node pathology, culture data, and patient records to define the prevalence, predisposing factors, microbiology, and clinical management of false-positive lymph node cultures at a large academic medical center. Nearly one third (31.9%) of 216 cultured lymph nodes yielded bacterial growth. Approximately 90% of positive bacterial cultures grew 1 of 2 common skin-resident taxa-coagulase-negative Staphylococcus and Cutibacterium acnes-with well-documented predispositions for contamination in other clinical settings. Lymph nodes excised from axillary, cervical, and inguinal regions yielded higher positive culture rates than nodes excised from the mediastinum, suggesting proximity to the skin surface may increase contamination risk. Accordingly, cultures from thoracoscopic pulmonary resections displayed contamination rates over 5-fold lower than those from percutaneously accessed lymph nodes. Lymph nodal tissue allocated for culture in the operating room yielded unexpectedly high contamination rates, significantly higher than cultures sent from the frozen section processing area. A significant minority of contamination events were noted in the clinical record and prompted antibiotic therapy on multiple occasions. Collectively, our results illuminate the risk factors contributing to bacterial contamination and argue that routine lymph node bacterial cultures provide minimal clinical benefit for adult patients. This widespread bacterial contamination also warrants cautious implementation of increasingly sensitive molecular microbiology tools for excised tissues.

中文翻译:

切除淋巴结活检中细菌污染的流行率和预测因素:对诊断和管理的影响。

常规组织处理使淋巴结标本暴露于微生物污染,这会混淆微生物培养结果并干扰诊断。这个问题的范围和影响仍然知之甚少。我们结合了超过 13 年的淋巴结病理学、培养数据和患者记录,以确定大型学术医疗中心假阳性淋巴结培养的患病率、诱发因素、微生物学和临床管理。216 个培养的淋巴结中近三分之一 (31.9%) 产生细菌生长。大约 90% 的阳性细菌培养物生长出 2 种常见的皮肤常驻分类群中的一种 - 凝固酶阴性葡萄球菌和痤疮皮肤杆菌 - 在其他临床环境中有充分记录的污染倾向。从腋窝、宫颈、腹股沟区域的阳性培养率高于从纵隔切除的淋巴结,这表明靠近皮肤表面可能会增加污染风险。因此,胸腔镜肺切除的培养物的污染率比经皮淋巴结的污染率低 5 倍以上。在手术室中分配用于培养的淋巴结组织产生了出乎意料的高污染率,明显高于从冷冻切片加工区送来的培养物。临床记录中记录了极少数污染事件,并多次促使抗生素治疗。总的来说,我们的结果阐明了导致细菌污染的风险因素,并认为常规淋巴结细菌培养对成年患者的临床益处微乎其微。这种广泛的细菌污染也保证了对切除组织越来越敏感的分子微生物学工具的谨慎实施。
更新日期:2021-07-09
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