Advantages of sonication fluid culture for the diagnosis of prosthetic joint infection

Portillo, María Eugenia; Salvadó, Margarita; Alier, Albert; Martínez, Santos; Sorlí, Lluïsa; Horcajada, Juan Pablo; Puig, Lluís

doi:10.1016/j.jinf.2014.03.002

Cited by 115 publications

(96 citation statements)

References 33 publications

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“…Culture samples obtained by sonication of removed artificial material were shown to be more sensitive than conventional tissue culture (78.5 vs. 60.8 %. ), especially in patients who were exposed to antiinfective treatment 14 days before surgery (45 vs. 75 %)-the overall specificities were above 98 % [6,7]. Only few studies have assessed the diagnostic utility of nucleic acid amplification test (NAAT) techniques in this context.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of prosthetic joint infections using UMD-Universal Kit and the automated multiplex-PCR Unyvero i60 ITI® cartridge system: a pilot study

et al. 2015

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cultures of periprosthetic tissue samples were compared with the results of broad-range 16S rRNA gene real-time PCR (UMD-Universal Pathogen DNA Extraction and PCR Analysis, Molzym GmbH, Germany) and the multiplex-PCR Unyvero ITI ® cartridge system (U-ITI; Curetis AG, Germany). Conventional culture and broad-range 16S rRNA gene real-time PCR were performed on all samples. U-ITI was used in a subgroup of 28 cases including all culture-positive cases. The agreement of the results from the methods was assessed. Results Of 54 cases, seven were culture-positive. Broadrange 16S rRNA gene real-time PCR gave 6, U-ITI 3 concordant positive results. Of the 47 culture-negative samples, 46 were also negative by broad-range 16S rRNA gene realtime PCR resulting in a 96 % (52/54) agreement between 16S rRNA gene PCR and culture. Of the 21 culture-negative samples analysed with U-ITI, 20 gave negative results, including the single 16S rRNA gene PCR-positive/culturenegative specimen. The rate of agreement between U-ITI and culture results was 82 % (23/28). Conclusion This pilot study gave no indication of superiority of the used NAATs over conventional culture methods for the microbiological diagnosis of PJI. Drawbacks are susceptibility to contamination in the case of 16S rRNA gene real-time PCR, labour-intensive DNA extraction and limited pathogen panel in the case of the multiplex cartridge PCR system. More prospective trials are needed to evaluate the diagnostic performance of NAATs and their impact on the clinical management of PJI. Keywords

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Section: Introductionmentioning

confidence: 99%

Diagnosis of prosthetic joint infections using UMD-Universal Kit and the automated multiplex-PCR Unyvero i60 ITI® cartridge system: a pilot study

et al. 2015

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“…Sonication was evaluated in infections involving prosthetic joints, fracture fixation devices, vascular grafts, neurosurgical shunts, breast implants, and cardiac devices (4)(5)(6)(7). Despite the use of sonication, however, cultures remain negative for several reasons, such as inappropriate culture media, short incubation time, loss of microbial viability during specimen transport, or prior antimicrobial therapy (8).…”

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Improved Diagnosis of Orthopedic Implant-Associated Infection by Inoculation of Sonication Fluid into Blood Culture Bottles

Salvadó²,

et al. 2015

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dSonication improved the diagnosis of orthopedic implant-associated infections (OIAI). We investigated the diagnostic performance of sonication fluid inoculated into blood culture bottles in comparison with that of intraoperative tissue and sonication fluid cultures. Consecutive patients with removed orthopedic hardware were prospectively included and classified as having OIAI or aseptic failure (AF) according to standardized criteria. The diagnostic procedure included the collection of five intraoperative tissue cultures and sonication of the removed device, followed by conventional culture of the sonication fluid. Cultures were incubated for 7 days (aerobic) or 14 days (anaerobic). In addition, 10 ml of sonication fluid was inoculated into each aerobic and anaerobic BacT/Alert FAN blood culture bottle and incubated in the automated blood culture system for 5 days. Of 75 included patients, 39 had OIAI and 36 AF. The sensitivity of sonication fluid inoculated into blood culture bottles (100%) was higher than that of conventional sonication fluid (87%; P ‫؍‬ 0.05) or intraoperative tissue cultures (59%; P < 0.01). Previous antibiotic therapy reduced the culture sensitivity of conventional sonication fluid to 77% and that of intraoperative tissue to 55%, while it remained 100% for blood culture-inoculated sonication fluid. The time to positivity was shorter in blood culture-inoculated sonication fluid, with detection of 72% of microorganisms after 1 day of incubation, than for intraoperative tissue and conventional sonication fluid cultures, with detection of 18% and 28% of microorganisms, respectively. In conclusion, compared to conventional sonication fluid and intraoperative tissue cultures, sonication fluid inoculated into blood culture bottles improved the diagnosis of OIAI and considerably reduced the time to culture positivity.T he pathogenesis of orthopedic implant-associated infections (OIAI) is related to biofilms, rendering these infections difficult to diagnose. Microorganisms in biofilms are embedded in a hydrated extracellular matrix, adhered to the surface, and transformed in a less metabolically active state than microorganisms in biofilms (1). An accurate diagnosis of OIAI is crucial for treatment success. A combination of various preoperative and intraoperative methods is usually needed for microbiological diagnosis of OIAI (2, 3). However, current diagnostic methods have limited sensitivity, with 10 to 30% false-negative results, and/or lack specificity (2).Research and development of new diagnostic methods aim to improve the diagnostic accuracy and speed of microbial detection in foreign-body infections. Sonication of explanted implants, designed to remove attached biofilms, significantly improved the culture sensitivity compared to that of conventional microbiological methods using synovial fluid or intraoperative tissue samples. Sonication was evaluated in infections involving prosthetic joints, fracture fixation devices, vascular grafts, neurosurgical shunts, breast implants, and cardiac dev...

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“…Five-or 7-day incubations have often been reported (9,13,15,17). However, some studies suggested prolonging the incubation period up to 14 days in order to reveal low-virulence microorganisms (29)(30)(31). Low-virulence microorganisms that adhere to foreign material are replicated slowly.…”

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“…They are characteristically in a dormant starved state and thus need longer culture incubation times (28,32). Portillo et al compared the time to culture tissue and sonication fluid in PJI and aseptic failure (31). They found that aerobic organisms were detected in SFC within 7 days, whereas anaerobes required up to 13 days of incubation.…”

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Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

Zhai

Qin

et al. 2014

J Clin Microbiol

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bThis meta-analysis included 12 studies that evaluated sonication fluid cultures (SFC) for the diagnosis of prosthetic joint infection (PJI). The pooled sensitivity and specificity were 0.80 (95% confidence interval [CI], 0.74 to 0.84) and 0.95 (CI, 0.90 to 0.98), respectively. Subgroup analyses showed that a 14-day anaerobic culture may improve sensitivity, the use of centrifugation or vortexing may improve specificity, and the use of 400 to 500 ml of Ringer's solution for containers may improve sensitivity and specificity. The best SFC cutoff was >5 CFU. In conclusion, SFC has high sensitivity and very high specificity for diagnosing PJI. P rosthetic joint infection (PJI), which occurs in 1 to 12% of surgical cases, is a common catastrophic complication of joint replacement (1-3). Hence, distinguishing PJI from other causes of joint failure, such as metal allergy or aseptic loosening, is important (4). Several tests for diagnosing PJI, including laboratory tests, nuclear medicine detection, rapid molecular tests, histopathology, and microbiologic culture (5-7), have limited sensitivity and specificity, which impedes the differentiation of PJI from other prosthetic failures (3,4,8).Sonication fluid cultures (SFC), which use sonication to dislodge bacteria from the prosthetic surface, have shown promising improvements in sensitivity compared with that for traditional tissue cultures (9). However, the sensitivities (range, 0.67 to 0.91) and specificities (range, 0.72 to 1.0) among studies assessing the diagnostic value of SFC for PJI are inconsistent (9-21). The Infectious Diseases Society of America guidelines suggest a gap in the validation of the diagnostic value of SFC for PJI and request additional higher-level evidence (8). Therefore, we evaluated the detection validity of SFC for PJI to provide further evidence for its clinical use.We searched Medline, EMBASE, and OVID for articles published between January 1990 and August 2013, using the following medical subject headings or free-text words: joint prosthesis, prosthesis infection, septic loosening, aseptic loosening, replacement, or arthroplasty; and sonication, sonicate, or ultrasonicate. We also manually searched the reference lists of eligible studies

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Advantages of sonication fluid culture for the diagnosis of prosthetic joint infection

Cited by 115 publications

References 33 publications

Diagnosis of prosthetic joint infections using UMD-Universal Kit and the automated multiplex-PCR Unyvero i60 ITI® cartridge system: a pilot study

Diagnosis of prosthetic joint infections using UMD-Universal Kit and the automated multiplex-PCR Unyvero i60 ITI® cartridge system: a pilot study

Improved Diagnosis of Orthopedic Implant-Associated Infection by Inoculation of Sonication Fluid into Blood Culture Bottles

Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

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