Implant surface culture may be a useful adjunct to standard tissue sampling culture for identification of pathogens accounting for fracture-device-related infection: a within-person randomized agreement study of 42 patients

Abstract

Background and purpose: Identification of pathogens causing fracture-device-related infection (FDRI) is always a challenge as the positive rate of standard tissue sampling culture (TSC) remains unsatisfactory. This study evaluates the efficiency of implant surface culture (ISC) as an adjunct to standard TSC for identification of FDRI-associated microorganisms.Patients and methods: Between November 2020 and March 2022, patients diagnosed with FDRI defined by the International Fracture-Related Infection (FRI) Consensus Group, and indicated for implant removal, underwent both methods for bacteria detection. The test order of ISC and TSC was randomly selected for each patient included, as a within-person randomized design. For ISC, the recovered implants were gently covered with tryptic soy agar after rinsing with normal saline twice, and then incubated at 37℃ 5% CO2 for up to 14 days. For TSC, 5 specimens were sampled and sent to the Clinical Laboratory of Southern Medical University Nanfang Hospital, Guangzhou, for culture and identification.Results: 42 consecutive patients were included, with a mean age of 46 years. The most frequent infection site and implant type were the tibia (21 cases) and plates with screws (30 cases), respectively. Altogether 21 patients were found with positive outcomes by both methods, and the identified pathogens were consistent. ISC found an additional 15 patients showing positive results, which were negative by TSC. Furthermore, the mean culture time of ISC was shorter than that of TSC (1.5 days vs. 3.2 days).Interpretation: ISC may be a useful adjunct to TSC for detection of bacteria causing FDRI, with a relatively higher positive rate and a shorter culture time.

Mapping bacterial biofilm on explanted orthopedic hardware: An analysis of 14 consecutive cases

“…Two cases (11 and 14, identified as E. faecalis and S. warneri, respectively) that were ISC positive were also MSIS positive for PJI but clinical culture negative, implying that ISC may be useful in culturing pathogens from patients with confirmed PJI but unable to be detected from intraoperative culture samples. This aligns with a recent study by Jiang et al [16] where the "ISC" method was used to in fracture device-related infections (FDRI) and found to have an increased sensitivity and shorter mean culture time when compared with traditional culturing methods, suggesting this technique is a possible adjunct to traditional culturing. However, a larger population size is required to confirm the ability ISC to more effectively culture from PJI cases.…”

“…This aligns with a recent study by Jiang et al . [16] where the “ISC” method was used to in fracture device‐related infections (FDRI) and found to have an increased sensitivity and shorter mean culture time when compared with traditional culturing methods, suggesting this technique is a possible adjunct to traditional culturing. However, a larger population size is required to confirm the ability ISC to more effectively culture from PJI cases.…”

Solute carrier family 11 member 1 genetic polymorphisms rs17235409 and rs3731865 associate with susceptibility to extremity post‐traumatic osteomyelitis in a Chinese Han population

“…It is known the positive rate of culture is influenced by multiple factors, such as pathogen type, recent antibiotic use, culture condition, surgeons’ experience, and even the number of samples collected (Dudareva et al., 2021). Recently, several novel strategies had been introduced, aiming at increasing the detection rate of pathogens, and achieved fine efficiency, such as the implant surface culture (Jiang et al., 2022), the devascularized bone surface culture (Chen et al., 2022), and the culture of samples from the reamer–irrigator–aspirator system (Onsea et al., 2021). Considering the limited evidence on these methods, future studies are necessary.…”

Current Concepts of Fracture-Related Infection

“…Thus, they suggested combining the two methods. In addition, Jiang et al [ 57 ] introduced a novel method for pathogen identification, referred to as “implant surface culture,” which is based on the theory that there may exist residual bacterial biofilms attached to the implant surfaces. They found that this novel method can detect additional FRI-associated pathogens, which cannot be detected by the traditional method.…”