Is Treatment With Dithiothreitol More Effective Than Sonication for the Diagnosis of Prosthetic Joint Infection?

Sambri, Andrea; Cadossi, Matteo; Giannini, Sandro; Pignatti, G.; Marcacci, Maurilio; Neri, Maria Pia; Maso, Alessandra; Storni, Elisa; Gamberini, Simonetta; Naldi, Susanna; Torri, Arianna; Zannoli, Silvia; Tassinari, Martina; Fantini, Manuela; Bianchi, Giuseppe; Donati, Davide María; Sambri, Vittorio

doi:10.1007/s11999.0000000000000060

Cited by 49 publications

(38 citation statements)

References 19 publications

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“…ical culture media and it was shown that DTT cultures have a superior sensitivity than cultures from sonication fluid (85.7 vs. 71.4 %) with the same specificity (94.1 %). Another study with 232 patients by Sambri et al showed the same results with a sensitivity [24] of 91 % and a specificity of 99 % for the DTT cultures [32].…”

Section: Discussionmentioning

confidence: 58%

The Performance of a Dithiothreitol-Based Diagnostic System in Diagnosing Periprosthetic Joint Infection Compared to Sonication Fluid Cultures and Tissue Biopsies

et al. 2020

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Purpose The aim of this study was to evaluate the performance of a commercially available dithiothreitol (DTT) kit for routine use in diagnosing periprosthetic joint infections (PJIs) in comparison to conventional microbiological tissue specimens and sonication procedures in a maximal care hospital. Methods We applied the DTT system in 40 consecutive cases of revision arthroplasty (23 PJIs and 17 aseptic revisions), with an exchange or a removal of components. The hardware components were split between the DTT system and the conventional sonication procedure. At least three tissue biopsies and a joint fluid specimen were sent for microbiological and histopathological analysis. Data was analysed retrospectively to compare between the different methods. Results Cultures of the DTT fluid showed a sensitivity of 65% and specificity of 100%, as referenced to conventional microbiological cultures. Sonication had better sensitivity (75%) but lower specificity (85%). The categorical agreement of DTT cultures compared to sonication fluid cultures was 78% (31/40). Neither pathogen type, infection duration nor antibiotic pretreatment influenced the accuracy of the DTT, but a low pH in the DTT seemed to be associated with false-negative results. Conclusion DTT was inferior in sensitivity when diagnosing PJIs compared to sonication fluid cultures and tissue biopsies. A low pH in the DTT fluid correlated with false-negative results. Nevertheless, the closed system of the DTT kit avoids contamination and false-positive results, and DTT can be an alternative where sonication is not available.

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Section: Discussionmentioning

confidence: 58%

The Performance of a Dithiothreitol-Based Diagnostic System in Diagnosing Periprosthetic Joint Infection Compared to Sonication Fluid Cultures and Tissue Biopsies

et al. 2020

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“…As DTT is often one of cell culture media components and can be added directly to the medium [75], studies have demonstrated that DTT lacks selectivity and spatial resolution [76] and leads to cellulose-anchored biofilm formation in Mycobacterium tuberculosis cultures, which contain metabolically active but drug-tolerant bacteria [77,78]. Importantly, in certain studies, while DTT has been implemented as a therapy-oriented approach or treatment of some syndromes and complications [63,79], its efficacy remains poorly understood [80]. Therefore, we think it is necessary to summarize the current studies to highlight the potential risks of DTT-involved approaches as presented graphically in Figure 3.…”

Section: Current Insights Into the Dtt-induced Reductive Stressmentioning

confidence: 99%

“…Moreover, the concentration of DTT is closely related to DNA protection or DNA damage [74]. In addition, further investigations on its drug-tolerance and therapy as well as efficacy should also be highly warranted [63,[77][78][79][80]. 4 Oxidative Medicine and Cellular Longevity morphological abnormalities cannot be identified in some studies in spite of the presence of severe cardiomyopathy and mitochondrial dysfunction [88].…”

Section: Downregulationmentioning

confidence: 99%

Reductive Stress-Induced Mitochondrial Dysfunction and Cardiomyopathy

Tao

et al. 2020

Oxidative Medicine and Cellular Longevity

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The goal of this review was to summarize reported studies focusing on cellular reductive stress-induced mitochondrial dysfunction, cardiomyopathy, dithiothreitol- (DTT-) induced reductive stress, and reductive stress-related free radical reactions published in the past five years. Reductive stress is considered to be a double-edged sword in terms of antioxidation and disease induction. As many underlying mechanisms are still unclear, further investigations are obviously warranted. Nonetheless, reductive stress is thought to be caused by elevated levels of cellular reducing power such as NADH, glutathione, and NADPH; and this area of research has attracted increasing attention lately. Albeit, we think there is a need to conduct further studies in identifying more indicators of the risk assessment and prevention of developing heart damage as well as exploring more targets for cardiomyopathy treatment. Hence, it is expected that further investigation of underlying mechanisms of reductive stress-induced mitochondrial dysfunction will provide novel insights into therapeutic approaches for ameliorating reductive stress-induced cardiomyopathy.

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“…Adjunctive techniques to improve the identification of an infecting organism should be considered even though not used in this case report. To potentially reduce false negative culture results, a study by Sambri et al reported that the culture of fluid from explanted components treated with either sonication or dithiothreitol improved sensitivity compared to routine tissue culture [12]. Alternatively, Zannoli et al and Sambri et al demonstrated that polymerase chain reaction (PCR) assays could also be used to assist in the timely identification of organisms [13,14].…”

Section: Case Reports In Orthopedicsmentioning

confidence: 99%

Modified Two-Stage Exchange for Periprosthetic Joint Infection in UKA

Yun

Qutami

Pasko

2020

Case Reports in Orthopedics

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Periprosthetic joint infection (PJI) is a rare complication following unicompartmental knee arthroplasty (UKA), and current management guidelines are still evolving. This report presents a novel surgical technique of resection arthroplasty with an articulated hemispacer as part of a 2-stage exchange protocol. A 66-year-old man developed a culture-negative PJI four months after a medial UKA. Rather than conventional full resection arthroplasty, the patient underwent partial resection with preservation of the lateral and patellofemoral compartments to maintain vascularized bone stock. An articulating hemispacer fashioned from the old implants after sterilization was reimplanted medially to preserve function during the course of antibiotic treatment. After successful eradication of infection, the patient underwent an uncomplicated conversion total knee replacement facilitated by prior preservation of bone stock. No stems or augments were needed. Therefore, a partial resection arthroplasty with an articulating hemispacer used in a 2-stage exchange protocol may be a reasonable option to eradicate infection and maintain function. In future cases of infected UKA, this technique warrants further consideration and investigation.

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Is Treatment With Dithiothreitol More Effective Than Sonication for the Diagnosis of Prosthetic Joint Infection?

Cited by 49 publications

References 19 publications

The Performance of a Dithiothreitol-Based Diagnostic System in Diagnosing Periprosthetic Joint Infection Compared to Sonication Fluid Cultures and Tissue Biopsies

The Performance of a Dithiothreitol-Based Diagnostic System in Diagnosing Periprosthetic Joint Infection Compared to Sonication Fluid Cultures and Tissue Biopsies

Reductive Stress-Induced Mitochondrial Dysfunction and Cardiomyopathy

Modified Two-Stage Exchange for Periprosthetic Joint Infection in UKA

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