PCR-hybridization after sonication improves diagnosis of implant-related infection

Esteban, Jaime; Alonso-Rodriguez, Noelia; del-Prado, Gema; Ortíz-Pérez, Alberto; Molina-Manso, Diana; Cordero‐Ampuero, José; Sandoval, Enrique; Fernández-Roblas, R.; Gómez‐Barrena, Enrique

doi:10.3109/17453674.2012.693019

Cited by 77 publications

(68 citation statements)

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“…The identification of the causative microorganisms solely by tissue cultures has been unhelpful in a large proportion of cases, particularly in those with previous use of antibiotics (10). For this reason, several researchers have applied a sonication (low-intensity ultrasound) technique to displace microorganisms from the surface of removed prosthetic devices, and they eventually were able to demonstrate an increase in the rate of etiological diagnosis compared to that with periprosthetic tissue cultures (11,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Since skincontaminating bacteria produce many osteosynthesis infections, comparing the sonication results of prosthetic joint infection to those of fracture fixation infections is not an easy task.…”

Section: Discussionmentioning

confidence: 99%

Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

et al. 2014

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Previous studies have shown that sonication fluid cultures from removed orthopedic devices improved the microbiological diagnosis of orthopedic implant-associated infections; however, few of these investigations have applied sonication to the removed fracture fixation devices to evaluate its utility for the diagnosis of osteosynthesis-associated infection (OAI). We compared sonication fluid to conventional tissue cultures from 180 subjects with different sizes of plates and screws (n ‫؍‬ 156), spinal implants (n ‫؍‬ 26), and intramedullary nails (n ‫؍‬ 3), of whom 125 and 55 subjects had OAI and noninfected osteosynthesis (NIO), respectively. The sensitivity for detecting OAI was 90.4% for sonication fluid culture and 56.8% for periprosthetic tissue cultures (P < 0.05), and the specificities were 90.9% and 96.4%, respectively. Sonication fluid culture detected more pathogens than peri-implant tissue culture (113 versus 71; P < 0.001), while polymicrobial infections were diagnosed by sonication fluid cultures and tissue cultures in 20.8% and 8% (P < 0.001), respectively. Microbiological diagnosis was achieved exclusively by sonication fluid cultures for 47 (90.4%) subjects, and among them, 18 (38.3%) had previously received antibiotics, whereas in five (9.6%) infected subjects, tissue culture was positive and the sonication fluid culture was negative. Among 39 (31.2%) OAI cases receiving antibiotics, the identification of the organisms occurred in 38.5% and 82.1% of the tissue and sonication fluid cultures, respectively (P < 0.049). We demonstrated that sonication fluid culture from removed osteosyntheses has the potential for improving the microbiological diagnosis of OAI. Due to the increasing occurrence of trauma and injuries, particularly those associated with road traffic accidents (1), surgical implantation of orthopedic devices for fracture fixations (or osteosynthesis), including intramedullary nails, different size plates, screws, and external fixation pins, have increased. Indeed, the acute management of bone fractures in trauma patients has evolved steadily, and there is an expanded indication for osteosynthesis, with the aim of early stabilization of the fractures. Depending upon the physiological condition of the patient, especially those with unstable polytrauma and significant lower extremity injuries, surgeons must choose the less aggressive external fixation first step for fracture stabilization (2). Once the adequate local wound debridement is ensured, which includes the removal of all dead and infected tissues and the stabilization of the systemic clinical condition of the patient, secondary major osteosynthesis is then performed with either plates and screws or intramedullary nails (3).Following orthopedic surgery, secondary soft tissue and implant-associated bone infections are still the most important negative aspects and limiting factors of success, leading to significant morbidity, including delayed bone union or nonunion, multiple additional debridement, or even amputation. Wound contamin...

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Section: Discussionmentioning

confidence: 99%

Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

et al. 2014

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“…However, the sensitivities (range, 0.67 to 0.91) and specificities (range, 0.72 to 1.0) among studies assessing the diagnostic value of SFC for PJI are inconsistent (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). The Infectious Diseases Society of America guidelines suggest a gap in the validation of the diagnostic value of SFC for PJI and request additional higher-level evidence (8).…”

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confidence: 99%

“…PCR techniques have demonstrated beneficial diagnostic value for diagnosing PJI; compared to intraoperative tissue culture, they theoretically have higher sensitivities and shorter turnaround times and are not as affected by treatment (6,10,14,15,21,35). However, differences in sample types analyzed by PCR may influence the diagnostic accuracy.…”

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confidence: 99%

“…Second, not all of the examined studies explicitly stated whether they were performed prospectively, which may reduce the strength of our study conclusions. Third, despite the absence of study bias indicated by the Deeks' funnel plot asymmetry test, a number of the significant differences in the subgroup analyses are based on only two studies that may have originated in the same research group (shoulder or elbow [15,20], cutoffs Ն1 CFU [9,16], cutoffs Ն5 CFU [9,11], and specimens processed within 24 to 48 h [10,13]). …”

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confidence: 99%

“…However, differences in sample types analyzed by PCR may influence the diagnostic accuracy. Sonication prosthetic fluid samples may offer additional insight for improving the diagnostic accuracy of PCRs (6,10,14,15,21,35). We previously performed a metaanalysis to evaluate PCR assays for diagnosing PJI (6).…”

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Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

Zhai

Qin

et al. 2014

J Clin Microbiol

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bThis meta-analysis included 12 studies that evaluated sonication fluid cultures (SFC) for the diagnosis of prosthetic joint infection (PJI). The pooled sensitivity and specificity were 0.80 (95% confidence interval [CI], 0.74 to 0.84) and 0.95 (CI, 0.90 to 0.98), respectively. Subgroup analyses showed that a 14-day anaerobic culture may improve sensitivity, the use of centrifugation or vortexing may improve specificity, and the use of 400 to 500 ml of Ringer's solution for containers may improve sensitivity and specificity. The best SFC cutoff was >5 CFU. In conclusion, SFC has high sensitivity and very high specificity for diagnosing PJI. P rosthetic joint infection (PJI), which occurs in 1 to 12% of surgical cases, is a common catastrophic complication of joint replacement (1-3). Hence, distinguishing PJI from other causes of joint failure, such as metal allergy or aseptic loosening, is important (4). Several tests for diagnosing PJI, including laboratory tests, nuclear medicine detection, rapid molecular tests, histopathology, and microbiologic culture (5-7), have limited sensitivity and specificity, which impedes the differentiation of PJI from other prosthetic failures (3,4,8).Sonication fluid cultures (SFC), which use sonication to dislodge bacteria from the prosthetic surface, have shown promising improvements in sensitivity compared with that for traditional tissue cultures (9). However, the sensitivities (range, 0.67 to 0.91) and specificities (range, 0.72 to 1.0) among studies assessing the diagnostic value of SFC for PJI are inconsistent (9-21). The Infectious Diseases Society of America guidelines suggest a gap in the validation of the diagnostic value of SFC for PJI and request additional higher-level evidence (8). Therefore, we evaluated the detection validity of SFC for PJI to provide further evidence for its clinical use.We searched Medline, EMBASE, and OVID for articles published between January 1990 and August 2013, using the following medical subject headings or free-text words: joint prosthesis, prosthesis infection, septic loosening, aseptic loosening, replacement, or arthroplasty; and sonication, sonicate, or ultrasonicate. We also manually searched the reference lists of eligible studies

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Obtaining High Quality DNA from Diverse Clinical Samples

Melton-Kreft

Spirk

2016

CP Microbiology

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Nucleic acids can be obtained in numerous ways from clinical specimens; however, the quality of the nucleic acid is only as good as the sampling and isolation protocol. While nucleic acids may be extracted they may not be representative of the original source. Large areas of tissue and explanted hardware must be successfully surveyed to reflect the overall clinical picture. Once good sampling technique has been established, successful bacterial nucleic acid isolation is essential. Clinical samples may be difficult to process because of the presence of scar tissue, bone, implants, and bacterial biofilms. The following protocols provide details on sampling techniques and DNA isolation from a variety of clinical samples which can then be used in downstream molecular applications including PCR-MS-ESI-TOF technology.

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PCR-hybridization after sonication improves diagnosis of implant-related infection

Cited by 77 publications

References 24 publications

Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

Obtaining High Quality DNA from Diverse Clinical Samples

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