Experience With the Use of the MicroDTTect Device for the Diagnosis of Low-Grade Chronic Prosthetic Joint Infections in a Routine Setting

Abstract

Background: In prosthetic joint infections (PJIs), identification of the causative microorganisms is critical to successfully adapt and optimize treatment. However, microbiological diagnosis of PJIs remains a challenge notably because bacteria are embedded in biofilm adhered to the prosthetic material. Recently, dithiothreitol (DTT) treatment of prosthesis has been proposed as a new strategy to release bacteria from biofilm and to improve the yield of microbiological diagnosis. In this study, we evaluated the interest of a commercial device using DTT, the MicroDTTect system (Heraeus, Hanau, Germany), for the diagnosis of low-grade chronic PJIs, compared to the conventional culture of periprosthetic tissue (PPT) samples.Methods: Twenty patients undergoing a surgery procedure for removal of prosthetic material because of a suspicion of low-grade PJI without pre-operative microbiological documentation were included (NCT04371068). Bacteriological results using the fluid obtained after prosthesis treatment with the MicroDTTect system were compared to results obtained with conventional culture of PPT samples.Results: All the bacteria considered as responsible for PJIs recovered from culture of PPT samples were also detected using the MicroDTTect device. For one patient, an additional bacterial isolate (Staphylococcus haemolyticus) suspected to be involved in a polymicrobial PJI was identified using DTT treatment. Time to positivity of the cultures was also reduced using the MicroDTTect system, notably in case of Cutibacterium acnes infection. However, probable bacterial contaminants were found (MicroDTTect system, n = 5; PPT samples, n = 1).Conclusion: This study showed that DTT treatment of the prosthetic component using the MicroDTTect device could improve the microbiological diagnosis of low-grade PJIs.

The diagnostic potential of MicroDTTect compared to conventional culture of tissue samples in orthopedic infections

“…Although with a low level of evidence, our data confirms the results of Calori 16 and Kolenda 20 . MicroDTTect had greater sensitivity compared to conventional culture of tissue samples.…”

“…In our study, periprosthetic, periosteosynthetic device, and pericement spacer infections were investigated when there was failure and loosening of the implant. As sustained by Kolenda et al 20 and Sambri et al 14 in their studies, low-grade and chronic infections can be difficult to detect and DTT treatment and MicroDTTect may be useful especially in cases when peri-implant infection is not suspected preoperatively.…”

Commentary: Dithiothreitol (DTT), When Used as Biofilm Detaching Method to Diagnose Implant-Associated Infections, Does Not Affect Microorganisms' Viability, According to the Current Literature

“…The hypothesis that dithiothreitol may have a toxic effect is clearly contradicted by the same literature that the authors cite, including the large clinical trials performed by Sambri et al (2018) and by Kolenda et al (2021) as well as other relevant studies (Table 1).…”

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

“…More recently, it was shown that, compared to the conventional culture of periprosthetic tissue samples, a commercial device using DTT, the MicroDTTect system, was able to improve the microbiological diagnosis of lowgrade PJIs throughout the identification of additional bacteria. Furthermore, it reduced the time to positivity of cultures, especially in the case of C. acnes infection (Kolenda et al, 2021).…”