Identification of silent prosthetic joint infection: preliminary report of a prospective controlled study

Abstract

PurposeWe will test the hypothesis that ultrasound supported by polymerase chain reaction (PCR) could improve bacterial identification in non-infected prosthetic joint loosening. The aim was to detect bacterial species in non-infected prosthetic joint loosening using ultrasound and 16S rRNA gene sequencing.MethodsA total of 16 patients (11 women and five men) aged 46–80 years (mean age 65.7) with diagnosed knee or hip implant loosening (mean implant survival of 102.1 months) were investigated. Bacterial culture and DNA sequencing were used to detect bacteria on the surface of failed implants removed during revision arthroplasty. The results of pre- and intraoperative culture and DNA sequencing were compared. Histopathological analysis was also performed.ResultsThe number of positive cultures rises with a higher level of C-reactive protein (CRP). The results of the cultures from synovial fluid obtained through joint aspiration were consistent with sonicates from components of prostheses in 12 cases (75 %). Bacterial DNA was found in 90 % of patients with negative synovial fluid culture. PCR revealed two or more bacterial species, often of the same genus: Ralstonia pickettii, Pseudomonas spp., Brevibacterium spp., Lactobacillus spp., Propionibacterium spp. and Staphylococcus spp.These are micro-organisms present in the environment or on the human body and often associated with compromised immunity.ConclusionsThe ultrasound procedure followed by PCR and sequencing improve bacterial identification in silent prosthetic joint infection. The lack of clinical signs of infection and negative preoperative and intraoperative cultures do not exclude the presence of micro-organisms on the implants.

Sonication culture improves microbiological diagnosis of modular megaprostheses

“…Other pathogens only detected in SC in patients with positive MSIS criteria were Micrococcus species, F. magna, B. Casei, and E. faecium . These bacteria are also part of the environment of the human body and commonly associated with compromised immune defense often seen in tumor patients or patients with chronic infections . Thus, they could be associated with low‐grade periprosthetic infections, which often show negative intraoperative TC.…”

Prosthetic joint and implant contamination caused byRalstonia pickettii: a report of three cases

“…Prosthetic joint infections occur in up to 4% of primary hip, knee, and shoulder arthroplasties and at greater frequency in revision arthroplasties [10–12]. Only 11–23% of PJIs are attributed to Gram-negative bacteria; such infections may be particularly challenging due to increased virulence and antimicrobial resistance [13].…”

“…In a previous report, a collection of organisms that included Ralstonia species, were incidentally identified in patients with aseptic prosthesis loosening following sonication and PCR. The pathogenicity of Ralstonia in this series was inconclusive [10]. …”

Remote transient Lactobacillus animalis bacteremia causing prosthetic hip joint infection: a case report

“…are rarely reported as causes of prosthetic joint infections [1–3] and the remote bacteremia appeared to be a likely cause of this patient’s infection. To prove this, whole genome sequencing was performed.…”