Microbiological Diagnosis of Implant-Related Infections: Scientific Evidence and Cost/Benefit Analysis of Routine Antibiofilm Processing

Abstract

Prosthetic joint infection is one of the most severe complication following joint arthroplasty, producing a significant worsening of patient's quality of life. Management of PJIs requires extended courses of antimicrobial therapy, multiple surgical interventions and prolonged hospital stay, with a consequent economic burden, which is thought to markedly increase in the next years due to the expected burden in total joint arthroplasties. The present review summarizes the present knowledge on microbiological diagnosis of prosthetic joint infections, focusing on aethiological agents and discussing pros and cons of the available strategies for their diagnosis.Intra-operative clinical diagnosis and pathogen identification is considered the diagnostic benchmark, however the presence of bacterial biofilm makes pathogen detection with traditional microbiological techniques highly ineffective. Diagnosis of PJIs is a rather complex challenge for orthopedics and requires a strict collaboration between different specialists: orthopaedics, infectivologists, microbiologists, pathologists and radiologists. Diagnostic criteria have been described by national and international association and scientific societies. Clinicians should be trained on how to use it, but more importantly they should know potential and limitation of the available tests in order to use them appropriately.

The World Association against Infection in Orthopaedics and Trauma (WAIOT) procedures for Microbiological Sampling and Processing for Periprosthetic Joint Infections (PJIs) and other Implant-Related Infections

“…Staphylococci are the most frequently isolated microorganisms in both early and late infections [22]. Coagulase negative staphylococci, such as Staphyloccocus epidermidis , Staphyloccocus lugdunensis , Staphyloccocus capitis , Staphyloccocus hominis , Staphyloccocus caprae are the most common organisms isolated in PJIs (30–43%), followed by S. aureus (12–23%) [23,24,25,26]. Streptococci, enterococci and diphtheroids are isolated in about 10% of cases, and gram-negative bacteria (Enterobacteriaceae and Pseudomonas) in about 8% [25].…”

Proteomic Analysis Reveals a Biofilm-Like Behavior of Planktonic Aggregates of Staphylococcus epidermidis Grown Under Environmental Pressure/Stress

“…Successful treatment relies on establishing whether the case is related to aseptic loosening or implant infection. Unfortunately, the diagnostic criteria for PJIs are based on tests that are not reliably predictive for implant-associated infections (e.g., C-reactive protein, erythrocyte sedimentation rate) (Berger et al, 2017), which poses diagnostic challenges especially when confronted with a chronic state not characterized by severe signs of infection caused by low-virulence bacteria like S. epidermidis (Drago and De Vecchi, 2017; Li et al, 2018).…”

Challenges in the Microbiological Diagnosis of Implant-Associated Infections: A Summary of the Current Knowledge

“…Based on the work done by Drago et al, also De Vecchi et al (2016) conducted a study on periprosthetic tissue samples treated with DTT for the diagnosis of PJIs compared with simple washing in normal saline. Treatment with DTT showed a sensitivity of 88% and specificity of 97.8%, significantly higher than those obtained for saline (72% and 91.1%, respectively) (Drago and De Vecchi, 2017). The same research group has expanded the DTT treatment by enriching it with specific culture broths for aerobic and anaerobic bacteria suggesting that this approach may be useful to increase the detachment of bacteria from biofilm and optimize bacterial growth and PJIs diagnosis (De Vecchi et al, 2017).…”