Online Program

Risk factors for escherichia coli growth in preprocessing cultures of musculoskeletal allograft tissue

Monday, November 4, 2013

Margo Klar, MPH, Department of Epidemiology, College of Public Health and Health Professionals and College of Medicine, University of Florida, Gainesville, FL
Lennox Archibald, MD, PhD, Department of Medicine in the College of Medicine, University of Florida, FL
Background: Each year, approximately 1.3 million cadaveric musculoskeletal allografts are used in orthopedic procedures. The Centers for Disease Control and Prevention has identified Escherichia coli as a common cause of allograft-associated infections. Thus, the Food and Drug Administration (FDA) has issued new standards requiring tissue banks to obtain pre-processing cadaveric tissue cultures. We conducted this study to identify risk factors associated with E. coli contamination of pre-processing allograft tissues. Methods: This was a case-control study: cases were defined as cadaveric donors with positive cultures for E. coli during January-May 2003. Controls were randomly selected donors with negative cultures during the same period. Results: Twenty-four cases and forty-nine controls were ascertained. Risk factors included dissection performed by fewer than three personnel (OR= 5.6, CI: 1.49-21.27, p=0.006); death outside the hospital versus inpatient (OR= 3.7, CI: 1.23-11.24, p=0.017); and procurement following autopsy (p=0.003). Place of tissue recovery (hospital vs. non-hospital) was not associated with contamination (OR=1.49, CI: 0.46-4.9, p= 0.507). Conclusions: Regulatory agencies (e.g., FDA) and the American Association of Tissue Banks (AATB) need data from studies like this to formulate guidelines for recovery and processing of allograft tissues. Public Health Significance: With millions of allografts being implanted every year, data like these are necessary to enhance patient safety.

Learning Areas:

Clinical medicine applied in public health
Other professions or practice related to public health
Public health biology
Public health or related organizational policy, standards, or other guidelines
Public health or related research

Learning Objectives:
Describe the risk factors associated with E. coli contamination of pre-processing allograft tissues. Identify potential sources of contamination to reduce occurrence of allograft-associated infections. Evaluate these common sources of contamination as a means of establishing regulatory guidelines that enhance patient safety.

Keyword(s): Infectious Diseases, Quality Assurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD student focused on infection control. In addition, I am the principal investigator of a Bill and Melinda Gates Grant funding an investigation of an umbilical cord cutting device to reduce umbilical cord infections.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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