Does Use of Lidocaine Affect Culture of Synovial Fluid Obtained to Diagnose Periprosthetic Joint Infection (PJI)? An In Vitro Study

Abstract

BackgroundSynovial fluid culture (SFC) is recommended as one of the major diagnostic criteria by the Musculoskeletal Infection Society (MSIS) for diagnosing periprosthetic joint infection (PJI). Local anesthetic agents are used for anesthesia and analgesia in some clinical settings to relieve pain. As a local anesthetic, lidocaine is safely used in arthrocentesis to obtain synovial fluid. The goal of this study was to determine if infiltration anesthesia with additive-free lidocaine 2% has antibacterial effects that might interfere with subsequent SFC.Material/MethodsEight isolates of reference strains of Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis, Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Streptococcus pyogenes, and Candida albicans were incubated on the plates. Each bacterial suspension was formed by 50-fold dilution before the test lidocaine 2% was added. For each strain, bacterial suspension was divided into 2 groups (5 samples each) exposed either lidocaine 2% or sterile non-bacteriostatic 0.45% saline. The antimicrobial property of lidocaine 2% was determined by measuring the bacterial density on agar plates incubated for 24 h and comparing it with controls unexposed to lidocaine 2%.ResultsExposure to lidocaine 2% negatively affected microbial viability in vitro. Of the lidocaine 2% exposure, reference strains but no Streptococcus pyogenes strain resulted in fewer colony-forming units compared with the sterile saline control. The antibacterial property of lidocaine 2% appears to affect the ability to culture the organism in synovial fluid.ConclusionsLidocaine 2% has strong antimicrobial activities against some commonly encountered bacterial strains in PJI. As a result, infiltration anesthesia with additive-free lidocaine 2% before the arthrocentesis procedure may affect the results of SFC. To further evaluate its potential antibacterial usefulness in clinical applications, studies are needed to assess the ability of lidocaine to reduce the risk of iatrogenic infections.

Antimicrobial effect of methylene blue in microbiologic culture to diagnose periprosthetic joint infection: an in vitro study

“…To preliminarily examine the concept that methylene blue (MB) can produce false-negative results of bacterial culture, an in vitro experiment was performed to test the antibacterial properties of MB on common PJI pathogenic bacteria, which was the same as the previous publication of our study [ 12 ]. The bacteria used in this study were 8 isolates of reference strains of Staphylococcus aureus (SAU) (ATCC 25923), Staphylococcus epidermidis (SEP) (ATCC 14990), Staphylococcus hominis (SHO) (ATCC 27844), Escherichia coli (ECO) (ATCC 11775), Klebsiella pneumoniae (KPN) (ATCC 13883), Acinetobacter baumannii (ABA) (ATCC 19606), Streptococcus pyogenes (SPY) (ATCC 12344), and Candida albicans (CAL) (ATCC 90028), all originally from the American Type Culture Collection, Manassas, VA).…”

“…According to the results of recent studies, several disclosing agents with various contents may have a role in quickly detecting biofilms on orthopedic prostheses [9][10][11][12]. To be used effectively in an operative setting, a disclosing agent would need to stain biofilm on the implant or tissue and have limited antimicrobial activity, so the organism could be grown in culture.…”

A Ação Antimicrobiana E Imunomoduladorados Anestésicos Locais

“…Outra situação em que o anestésico local pode ter ação negativa, é em culturas do líquido sinovial. Em seu experimento in vitro, Liu et al (2018) definiram que a infiltração de Lidocaína a 2% teve efeito antibacteriano em 8 isolados, sendo estes: Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus hominis, Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Streptococcus pyogenes e Candida albicans. Segundo os autores, a densidade bacteriana incubada neste estudo foi supra-fisiológica e a Lidocaína afetou de forma rápida e significativa a viabilidade microbiana de todas as cepas, exceto do Streptococcus pyogenes, sendo que Staphylococcus aureus, Staphylococcus epidermidis, Acinetobacter baumannii e Klebsiella pneumoniae foram os microrganismos mais susceptíveis.…”

“…Com base nisto, é possível perceber que esse anestésico local, em concentrações próximas à utilizada em seu uso clínico, pode interferir negativamente na cultura do líquido sinovial, quando administrado na forma de injeção infiltrativa antes da coleta, o que poderia resultar em resultados falsonegativos. Apesar disso, um efeito benéfico também pode ser possível, caso a Lidocaína a 2% possa agir reduzindo a ocorrência de artrites sépticas de ocorrência iatrogênica (LIU et al, 2018).…”

Systematic review of single stage revision for prosthetic joint infection

“…Single stage revision should not be performed without this information as antibiotic treatment cannot be tailored to combat the infection. Aspiration of the joint is performed with the patient off antibiotics for at least 14 d, using an “as sterile as possible technique” and with a culture incubation period of 14 d. Studies have suggested anesthetics such as lidocaine and ethyl chloride spray can affect bacterial growth[ 18 , 19 ]. Because of this, our institution does not use local anesthetic while aspirating the joint.…”