Use of dithiothreitol to improve the diagnosis of prosthetic joint infections

Abstract

Diagnosis of prosthetic joint infections (PJIs) remains a challenge for microbiologists, despite new techniques for bacteria isolation have been developed in recent years. A widely recognized standard method has not yet been indicated mainly because of limitations due difficult procedures and need of dedicated instrumentation. We evaluated the ability of a sulfhydryl compound routinely used in microbiology laboratories, dithiothreitol (DTT), to dislodge bacteria from biofilm, keeping them alive and cultivable for identification and antibiotic susceptibility testing. We compared DTT treatment against sonication of prosthesis and culture of periprosthetic tissues, in order to establish if it could be introduced in routine microbiological diagnosis of PJIs. The study was conducted on 76 patients, 34 with aseptic loosening of their prosthesis and 42 who were diagnosed for PJI. DTT treatment gave results similar to sonication in terms of bacterial yielding. Sonication provided higher sensitivity (71.4%) and specificity (94.1%) respect to periprosthetic tissue culture, while DTT showed the same specificity of sonication but a better sensitivity (85.7%), especially when the causative microorganism was Staphylococcus epidermidis. In conclusion, we demonstrated that DTT could be used for PJIs diagnosis, thanks to its ease of use and its high sensitivity and specificity. ß

Comparison of different human tissue processing methods for maximization of bacterial recovery

“…DTT has been recommended for tissue processing because of its high sensitivity, specificity, practicability, and relatively low cost [14, 15]. In this study, DTT was found to be as safe as homogenization in terms of bacterial viability.…”

Acute arrest of hematopoiesis induced by infection with Staphylococcus epidermidis following total knee arthroplasty: A case report and literature review

“…Biofilm formation may explain the phenomenon of culture-negative PJI. Novel methods, including DL-dithiothreitol and polymerase chain reaction using various probes, are being developed in order to improve the ability of microbiological culture in detecting the pathogenic causes of PJI (23,24).…”

Infection post-total knee replacement: current concepts

“…The theory behind this method is DTT would alter the extracellular matrix of biofilm and free bacteria from it. Using this method on 76 explanted septic and aseptic prosthesis, the authors observed that it improved the sensitivity of sonication (71 % vs 86 %) while its specificity remained similar (94 %) [37]. Use of other molecular techniques for improvement of culture results, such as polymerase chain reaction (PCR) using different probes has also been suggested [38,39].…”