Hip and Knee Section, Diagnosis, Pathogen Isolation, Culture: Proceedings of International Consensus on Orthopedic Infections

Abdel, Matthew P.; Akgün, Doruk; Akin, George; Akinola, Bolarinwa; Alencar, Paulo Gilberto Cimbalista de; Amanatullah, Derek F.; Babazadeh, Sina; Borens, Olivier; Cabral, Rui Manuel Vicente; Cichos, Kyle H.; Deirmengian, Carl; Steiger, Richard de; Ghanem, Elie; Gonçalves, João Rodolfo Radtke; Goodman, Stuart B.; Hamlin, Brian R.; Hwang, Katherine; Klatt, Brian A.; Lee, Gwo Chin; Manrique, Jorge; Moon, Andrew S.; Ogedegbe, Felix; Salib, Christopher G.; Tian, Shaoqi; Winkler, Tobias

doi:10.1016/j.arth.2018.09.020

Cited by 20 publications

(19 citation statements)

References 88 publications

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“…Sonication of the removed prosthetic materials has been advocated to improve the postoperative culture results (6,(8)(9)(10)(11)(12). This was backed-up by the international consensus meetings in Philadelphia in 2013 and 2018, with the advice to use sonication as an adjunct to periprosthetic tissue cultures (3).…”

Section: Ivyspring International Publishermentioning

confidence: 99%

“…Diagnosis of infection can be troublesome, especially in cases of low-grade chronic infection. The suspicion of infection is confirmed when cultures of synovial fluid and periprosthetic tissue turn positive (3,4). However, the sensitivity and specificity of standard tissue cultures are low, as they are reported to be 57-61% and 97-99% respectively (5,6).…”

Section: Introductionmentioning

confidence: 99%

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Sonication Leads to Clinically Relevant Changes in Treatment of Periprosthetic Hip or Knee Joint Infection

Hoekstra¹,

Veltman²,

Nurmohamed³

et al. 2020

J. Bone Joint Infect.

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Abstract. Background: Diagnosis of periprosthetic joint infection (PJI) can be troublesome. Sonication can be a helpful tool in culturing bacteria that are difficult to detect with standard tissue cultures. Aim of this study is to evaluate the clinical importance of our standardized sonication protocol in detecting periprosthetic joint infection.Materials and methods: All patients with revision surgery of a hip or knee prosthesis between 2011 and 2016 were retrospectively reviewed and divided in two groups: clinically suspected of infection or not suspected of infection. For both tissue culture and implant sonication, calculations of sensitivity and specificity were performed. Clinical relevance of sonication was evaluated by calculating in which percentage of patients' sonication influenced clinical treatment.Results: 226 patients with revision of a total hip prosthesis (122 patients) or a total knee prosthesis (104 patients) were included. Sensitivity of perioperatively taken tissue cultures was 94.3% and specificity was 99.3%. For sonication sensitivity was 80.5% and specificity was 97.8%.In the infection group eight patients (9%) with only one positive tissue culture and a positive sonication fluid culture with the same pathogen were found.Interpretation: Although sensitivity and specificity of sonication was lower compared to tissue cultures, periprosthetic joint infection could only be established in 8 patients (9%) suspected of infection because of a positive result of the sonication fluid culture.Sonication leads to clinically relevant changes in treatment and seems therefore to be a helpful diagnostic tool in clinical practice.

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Section: Ivyspring International Publishermentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sonication Leads to Clinically Relevant Changes in Treatment of Periprosthetic Hip or Knee Joint Infection

Hoekstra¹,

Veltman²,

Nurmohamed³

et al. 2020

J. Bone Joint Infect.

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“…26 These techniques increase the likelihood of a microbiological diagnosis. [27][28][29][30][31] Another possibility is a "hold specimen" order, where the ordering clinician collects a sample and requests it be held in a sterile manner. We enumerated some recommended indications for fungal and mycobacterial cultures in Table II.…”

Section: Discussionmentioning

confidence: 99%

Fungal and mycobacterial cultures should not be routinely obtained for diagnostic work-up of patients with suspected periprosthetic joint infections

Tai

Wengenack

Patel

et al. 2022

The Bone & Joint Journal

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Aims Fungal and mycobacterial periprosthetic joint infections (PJI) are rare events. Clinicians are wary of missing these diagnoses, often leading to the routine ordering of fungal and mycobacterial cultures on periprosthetic specimens. Our goal was to examine the utility of these cultures and explore a modern bacterial culture technique using bacterial blood culture bottles (BCBs) as an alternative. Methods We performed a retrospective review of patients diagnosed with hip or knee PJI between 1 January 2010 and 31 December 2019, at the Mayo Clinic in Rochester, Minnesota, USA. We included patients aged 18 years or older who had fungal, mycobacterial, or both cultures performed together with bacterial cultures. Cases with positive fungal or mycobacterial cultures were reviewed using the electronic medical record to classify the microbiological findings as representing true infection or not. Results There were 2,067 episodes of PJI diagnosed within the study period. A total of 3,629 fungal cultures and 2,923 mycobacterial cultures were performed, with at least one of these performed in 56% of episodes (n = 1,157). Test positivity rates of fungal and mycobacterial cultures were 5% (n = 179) and 1.2% (n = 34), respectively. After a comprehensive review, there were 40 true fungal and eight true mycobacterial PJIs. BCB were 90% sensitive in diagnosing true fungal PJI and 100% sensitive in detecting rapidly growing mycobacteria (RGM). Fungal stains were performed in 27 true fungal PJI but were only positive in four episodes (14.8% sensitivity). None of the mycobacterial stains was positive. Conclusion Routine fungal and mycobacterial stains and cultures should not be performed as they have little clinical utility in the diagnosis of PJI and are associated with significant costs. Candida species and RGM are readily recovered using BCB. More research is needed to predict rare non- Candida fungal and slowly growing mycobacterial PJI that warrant specialized cultures. Cite this article: Bone Joint J 2022;104-B(1):53–58.

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“…13,24,26 Os componentes explantados podem ser submetidos à sonicação para quebra do biofilme e, o lavado destes, podem ser enviados para cultura, o que pode ser útil em casos de infecções com culturas negativas. 26 Em situações nas quais haja positividade para outras amostras de tecido, a positividade do fluido sonicado só deve ser levada em consideração se houver neste mais que 5 unidades formadoras de colônia (CFU, na sigla em inglês). 27 A análise histopatológica dos tecidos pode ser, também, um fator de confirmação diagnóstica em casos com culturas do líquido sinovial negativas e em afrouxamentos assépticos suspeitos, tendo sensibilidade de 75% nos cortes por congelamento, com o limiar de 5 PMN/campo.…”

Section: Revisão Em Dois Estágiosunclassified

Infecção periprotética do joelho – Parte 2: Tratamento

Barretto

Campos

Ooka

2022

Rev Bras Ortop (Sao Paulo)

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ResumoDiversas modalidades de tratamento são propostas para as infecções periprotéticas, com índices de sucesso variáveis. No entanto, a eficácia está relacionada à seleção adequada dos casos para cada tipo de tratamento.O desbridamento com retenção do implante é indicado em infecções agudas com implante fixo, e seu sucesso depende do tipo de infecção, das comorbidades do hospedeiro e da virulência do agente etiológico.A revisão em um ou dois estágios se impõem nos casos em que haja formação de biofilme, ou nos quais se tenha afrouxamento do implante. A escolha entre realizar a revisão em um ou dois estágios depende de fatores como identificação do agente etiológico, virulência do patógeno, fatores locais e sistêmicos do hospedeiro.Os procedimentos de salvamento como artrodese, amputação, artroplastia de ressecção ou, ainda, supressão antibiótica são reservados para os casos em que não se conseguiu erradicação da infecção.

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Hip and Knee Section, Diagnosis, Pathogen Isolation, Culture: Proceedings of International Consensus on Orthopedic Infections

Cited by 20 publications

References 88 publications

Sonication Leads to Clinically Relevant Changes in Treatment of Periprosthetic Hip or Knee Joint Infection

Sonication Leads to Clinically Relevant Changes in Treatment of Periprosthetic Hip or Knee Joint Infection

Fungal and mycobacterial cultures should not be routinely obtained for diagnostic work-up of patients with suspected periprosthetic joint infections

Infecção periprotética do joelho – Parte 2: Tratamento

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