Challenges in the Microbiological Diagnosis of Implant-Associated Infections: A Summary of the Current Knowledge

Abstract

Implant-associated infections are characterized by microbial biofilm formation on implant surface, which renders the microbiological diagnosis challenging and requires, in the majority of cases, a complete device removal along with a prolonged antimicrobial therapy. Traditional cultures have shown unsatisfactory sensitivity and a significant advance in the field has been represented by both the application of the sonication technique for the detachment of live bacteria from biofilm and the implementation of metabolic and molecular assays. However, despite the recent progresses in the microbiological diagnosis have considerably reduced the rate of culture-negative infections, still their reported incidence is not negligible. Overall, several culture- and non-culture based methods have been developed for diagnosis optimization, which mostly relies on pre-operative and intra-operative (i.e., removed implants and surrounding tissues) samples. This review outlines the principal culture- and non-culture based methods for the diagnosis of the causative agents of implant-associated infections and gives an overview on their application in the clinical practice. Furthermore, advantages and disadvantages of each method are described.

Performance of Graphene/Polydimethylsiloxane Surfaces against S. aureus and P. aeruginosa Single- and Dual-Species Biofilms

“…Although they are extremely successful in supporting or even replacing damaged body organs, IMDs (e.g., cardiac implantable devices, hemodialyzers, urinary or central venous catheters, contact lenses, artificial breasts, and orthodontal and orthopedic prosthetics) carry the risk of inducing future infections, seriously affecting the patients’ health and even endangering their lives [ 3 , 4 , 5 ]. Implant-associated infections (IAIs) present a high incidence, corresponding to 60–70% of the nosocomial infections reported each year in the United States [ 6 ], and are responsible for a severe burden on healthcare systems and high economic costs [ 7 , 8 ].…”

The concordance between preoperative synovial fluid culture and intraoperative tissue cultures in periprosthetic joint infection: a systematic review

“…So, when using the preoperative synovial culture as a single test to distinguish between septic or aseptic implant failure, 1 in 3 to 4 cases may be misdiagnosed and subsequently be under-or over-treated. To diagnose PJI, current guidelines recommend the use of preoperative synovial fluid aspiration culture combined with leukocyte count and percentage of polymorphonuclear neutrophils (Oliva et al, 2021;Signore et al, 2019; American Academy of Orthopaedic Surgeons (AAOS), 2019). The results of our review suggest that a clinician cannot confidently establish a postoperative treatment strategy based on the preoperative cultures alone.…”

The Ratio of IL-6 to IL-4 in Synovial Fluid of Knee or Hip Performances a Noteworthy Diagnostic Value in Prosthetic Joint Infection

“…In particular, when PJI presents as a chronic capsular infection, the patient may experience a mild systemic response with normal serum laboratory markers. For this reason, the diagnosis of PJI presents great difficulties [ 8 , 30 ]. Therefore, accurately and timely diagnosis of PJI and accurately distinguishing between PJI and aseptic failure are the key measures to implement effective treatment [ 31 , 32 ].…”