Is sonication superior to dithiothreitol in diagnosis of periprosthetic joint infections? A meta-analysis

Tsikopoulos, Konstantinos; Christofilos, Savas Ilias; Kitridis, Dimitrios; Sidiropoulos, Konstantinos; Stoikos, Panagiotis N; Gravalidis, C.; Givissis, Panagiotis; Papaioannidou, Paraskevi

doi:10.1007/s00264-022-05350-z

Cited by 6 publications

(6 citation statements)

References 49 publications

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“…Finally, a recent meta-analysis pooling together data from more than 700 implants compared the diagnostic accuracy of sonication versus DTT in patients undergoing total hip or knee arthroplasty. The authors did not find any differences between the two methods after adjusting for baseline antibiotic use and study quality, in accordance with our results [35].…”

Section: Discussionsupporting

confidence: 92%

Role of Dithiothreitol in Detection of Orthopaedic Implant-Associated Infections

Bakalakos,

Vlachos,

Ampadiotaki

et al. 2024

JPM

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Orthopaedic implant-associated infections (OIAIs) represent a notable complication of contemporary surgical procedures, exerting a considerable impact on patient outcomes and escalating healthcare expenditures. Prompt diagnosis holds paramount importance in managing OIAIs, with sonication widely acknowledged as the preferred method for detecting biofilm-associated infections. Recently, dithiothreitol (DTT) has emerged as a potential substitute for sonication, owing to its demonstrated ability to impede biofilm formation. This study aimed to compare the efficacy of DTT with sonication in identifying microorganisms within implants. Conducted as a prospective cohort investigation, the study encompassed two distinct groups: patients with suspected infections undergoing implant removal (Group A) and those slated for hardware explantation (Group B). Hardware segments were assessed for biofilm-related microorganisms using both sonication and DTT, with a comparative analysis of the two methods. A total of 115 patients were enrolled. In Group A, no statistically significant disparity was observed between DTT and sonication. DTT exhibited a sensitivity of 89.47% and specificity of 96.3%. Conversely, in Group B, both DTT and sonication fluid cultures yielded negative results in all patients. Consequently, this investigation suggests that DTT holds comparable efficacy to sonication in detecting OIAIs, offering a novel, cost-effective, and readily accessible diagnostic modality for identifying implant-associated infections.

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Section: Discussionsupporting

confidence: 92%

Role of Dithiothreitol in Detection of Orthopaedic Implant-Associated Infections

Bakalakos,

Vlachos,

Ampadiotaki

et al. 2024

JPM

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“…Previous studies have shown that DTT is a reliable alternative to sonication for microbiological diagnoses of orthopedic infections and may be even more sensitive than sonication towards S. epidermidis , which is often involved in peri-implant infections [ 7 , 51 ]. Indeed, DTT has become an important diagnostic tool for illnesses linked to biofilms [ 52 , 53 , 54 ]; in fact, disulfide bonds have been known to be broken by reducing agents like sulfhydryl compounds such as DTT, yet they are a crucial part of many biological structures, such as the extracellular matrix that keeps biofilms together. The intricate combination of proteins, exopolysaccharides, and extracellular DNA that makes up the extracellular matrix in biofilms protects bacterial cells from external agents and enhances their ability to withstand antibiotics.…”

Section: Is It Possible To Detach Bacteria That Live In Floating Aggr...mentioning

confidence: 99%

Bacteria Living in Biofilms in Fluids: Could Chemical Antibiofilm Pretreatment of Culture Represent a Paradigm Shift in Diagnostics?

Drago,

Fidanza,

Giannetti

et al. 2024

Microorganisms

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Biofilms are multicellular aggregates of bacteria immersed in an extracellular matrix that forms on various surfaces, including biological tissues and artificial surfaces. However, more and more reports point out the fact that even biological fluids and semifluid, such as synovial liquid, blood, urine, or mucus and feces, harbor “non-attached” biofilm aggregates of bacteria, which represent a significant phenomenon with critical clinical implications that remain to be fully investigated. In particular, biofilm aggregates in biological fluid samples have been shown to play a relevant role in bacterial count and in the overall accuracy of microbiological diagnosis. In line with these observations, the introduction in the clinical setting of fluid sample pretreatment with an antibiofilm chemical compound called dithiothreitol (DTT), which is able to dislodge microorganisms from their intercellular matrix without killing them, would effectively improve the microbiological yield and increase the sensitivity of cultural examination, compared to the current microbiological techniques. While other ongoing research continues to unveil the complexity of biofilm formation in biological fluids and its impact on infection pathogenesis and diagnosis, we here hypothesize that the routine use of a chemical antibiofilm pretreatment of fluid and semi-solid samples may lead to a paradigm shift in the microbiological approach to the diagnosis of biofilm-related infections and should be further investigated and eventually implemented in the clinical setting.

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“…The formation and maturation of biofilm on implant surfaces reduces the antibiotic action, impedes the phagocytosis and killing of bacteria by neutrophils, and increases the colonization of germs [1][2][3]7]. The bacterial biofilm thus encourages the persistence of infection, which could lead to implant failure, non-union, and osteomyelitis [5].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, effective preventive and therapeutic measures to reduce the risks of implant-associated infections are necessary. Improvements in implant manufacturing and properties, the application of less invasive and tissue sparing surgical techniques, and perioperative local and systemic antibiotic prophylaxis have been considered to decrease the likelihood of infection development [1][2][3]5,7].…”

Section: Introductionmentioning

confidence: 99%

Are Absorbable Plates More Resistant to Infection Than Titanium Implants? An Experimental Pre-Clinical Trial in Rabbits

Kitridis,

Savvidis,

Cheva

et al. 2023

JFB

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Background: Infection of orthopaedic implants after internal fixation of bone fractures remains a major complication with occasionally devastating consequences. Recent studies have reported that the use of absorbable materials, instead of metallic ones, may lead to a lower incidence of postoperative infection. In this experimental pre-clinical animal study, we compared the infection rate between absorbable implants consisting of copolymers composed from trimethylene carbonate, L-polylactic acid, and D, L-polylactic acid monomers, and titanium implants after the inoculation of a pathogenic microorganism. Material and Methods: We used an experimental implant-related infection model in rabbits. Sixty animals were randomly and equally divided into two groups. In all animals, the right femur was exposed via a lateral approach and a 2.5 mm two-hole titanium plate with screws (Group A), or a two-hole absorbable plate and screws (Group B), were applied in the femoral shaft. Afterwards, the implant surface was inoculated with Pseudomonas Aeruginosa at a concentration of 2 × 108 CFU/mL. The primary outcome was the comparison of the incidence of developed infection between the two groups. The wound condition was monitored on a daily basis and radiographies were obtained at 12 weeks postoperatively. Infection-related laboratory markers (white blood cell count, erythrocyte sedimentation rate, and C-reactive protein values) were assessed at 3, 6, and 16 weeks postoperatively. Histologic analysis and cultures of tissue samples were also performed to evaluate the presence of infection. Results: Clinical and laboratory signs of infection were evident in 11 rabbits in Group A (36.7%), and 4 in Group B (13.3%). The difference between the groups was statistically significant (p = 0.04). Five animals in Group B (16.7%) had clinical and histologic signs of a foreign-body reaction with significantly elevated CRP and ESR values but no simultaneous presence of infection was identified (p = 0.04). Bone remodelling with thickening of the periosteum and surrounding sclerosis was demonstrated radiologically in animals developing infection or foreign-body reactions. Conclusions: Absorbable plates and screws show lower susceptibility to infection compared to titanium ones. However, their application is associated with foreign-body reaction and the potential need for a second surgical intervention.

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Is sonication superior to dithiothreitol in diagnosis of periprosthetic joint infections? A meta-analysis

Cited by 6 publications

References 49 publications

Role of Dithiothreitol in Detection of Orthopaedic Implant-Associated Infections

Role of Dithiothreitol in Detection of Orthopaedic Implant-Associated Infections

Bacteria Living in Biofilms in Fluids: Could Chemical Antibiofilm Pretreatment of Culture Represent a Paradigm Shift in Diagnostics?

Are Absorbable Plates More Resistant to Infection Than Titanium Implants? An Experimental Pre-Clinical Trial in Rabbits

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