Prosthesis Failure Within 2 Years of Implantation Is Highly Predictive of Infection

Portillo, María Eugenia; Salvadó, Margarita; Alier, Albert; Sorlí, Lluïsa; Martínez, Santos; Horcajada, Juan Pablo; Puig, Lluís

doi:10.1007/s11999-013-3200-7

Cited by 100 publications

(63 citation statements)

References 26 publications

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“…By inoculating sonication fluid into blood culture bottles, no false-positive results in this method were observed, therefore increasing the sensitivity without compromising specificity. By counting single-positive tissue samples, the specificity was compromised, as shown by false-positive tissue cultures in aseptic failure cases (29). In contrast, in the study by Shen et al (13), coagulase-negative staphylococci were isolated from some blood culture bottles inoculated with sonication fluid from patients with AF, which may reflect contamination or the misclassification of patients.…”

Section: Discussionmentioning

confidence: 96%

Improved Diagnosis of Orthopedic Implant-Associated Infection by Inoculation of Sonication Fluid into Blood Culture Bottles

Salvadó²,

et al. 2015

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dSonication improved the diagnosis of orthopedic implant-associated infections (OIAI). We investigated the diagnostic performance of sonication fluid inoculated into blood culture bottles in comparison with that of intraoperative tissue and sonication fluid cultures. Consecutive patients with removed orthopedic hardware were prospectively included and classified as having OIAI or aseptic failure (AF) according to standardized criteria. The diagnostic procedure included the collection of five intraoperative tissue cultures and sonication of the removed device, followed by conventional culture of the sonication fluid. Cultures were incubated for 7 days (aerobic) or 14 days (anaerobic). In addition, 10 ml of sonication fluid was inoculated into each aerobic and anaerobic BacT/Alert FAN blood culture bottle and incubated in the automated blood culture system for 5 days. Of 75 included patients, 39 had OIAI and 36 AF. The sensitivity of sonication fluid inoculated into blood culture bottles (100%) was higher than that of conventional sonication fluid (87%; P ‫؍‬ 0.05) or intraoperative tissue cultures (59%; P < 0.01). Previous antibiotic therapy reduced the culture sensitivity of conventional sonication fluid to 77% and that of intraoperative tissue to 55%, while it remained 100% for blood culture-inoculated sonication fluid. The time to positivity was shorter in blood culture-inoculated sonication fluid, with detection of 72% of microorganisms after 1 day of incubation, than for intraoperative tissue and conventional sonication fluid cultures, with detection of 18% and 28% of microorganisms, respectively. In conclusion, compared to conventional sonication fluid and intraoperative tissue cultures, sonication fluid inoculated into blood culture bottles improved the diagnosis of OIAI and considerably reduced the time to culture positivity.T he pathogenesis of orthopedic implant-associated infections (OIAI) is related to biofilms, rendering these infections difficult to diagnose. Microorganisms in biofilms are embedded in a hydrated extracellular matrix, adhered to the surface, and transformed in a less metabolically active state than microorganisms in biofilms (1). An accurate diagnosis of OIAI is crucial for treatment success. A combination of various preoperative and intraoperative methods is usually needed for microbiological diagnosis of OIAI (2, 3). However, current diagnostic methods have limited sensitivity, with 10 to 30% false-negative results, and/or lack specificity (2).Research and development of new diagnostic methods aim to improve the diagnostic accuracy and speed of microbial detection in foreign-body infections. Sonication of explanted implants, designed to remove attached biofilms, significantly improved the culture sensitivity compared to that of conventional microbiological methods using synovial fluid or intraoperative tissue samples. Sonication was evaluated in infections involving prosthetic joints, fracture fixation devices, vascular grafts, neurosurgical shunts, breast implants, and cardiac dev...

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Section: Discussionmentioning

confidence: 96%

Improved Diagnosis of Orthopedic Implant-Associated Infection by Inoculation of Sonication Fluid into Blood Culture Bottles

Salvadó²,

et al. 2015

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“…Classically thought to be related to a noninfectious inflammatory response, it may actually be triggered by microbial contamination(6, 7). Likewise, cases of prosthetic joint failure may be related to undiagnosed infection or contamination(8). This population of subtle cases represents a “hidden” prevalence of implantable device related infection.…”

Section: The Clinical Problemmentioning

confidence: 99%

Implantable Device-Related Infection

VanEpps

Younger

2016

Shock

218

190

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Over half of the nearly 2 million healthcare-associated infections can be attributed to indwelling medical devices. In this review we highlight the difficulty in diagnosing implantable device related infection and how this leads to a likely underestimate of the prevalence. We then provide a length-scale conceptualization of device related infection pathogenesis. Within this conceptualization we focus specifically on biofilm formation and the role of host immune and coagulation systems. Using this framework, we describe how current and developing preventative strategies target specific processes along the entire length-scale. In light of the significant time horizon for the development and translation of new preventative technologies, we also emphasize the need for parallel development of in situ treatment strategies. Specific examples of both preventative and treatment strategies and how they align with the length-scale conceptualization are described.

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“…It is increasingly recognized that many presumably aseptic revisions are infected [2,16]. Because treatment of PJI differs considerably from the treatment of aseptic failure, it is important to distinguish the two entities before treatment [26].…”

Section: Introductionmentioning

confidence: 99%

“…The diagnosis of PJI can be challenging, particularly in patients with low-grade infections with nonspecific clinical presentation and the absence of systemic laboratory markers of inflammation. An inappropriate assumption that a potentially septic process is actually an aseptic one leads to repeat revisions with serial early failures and gradual function loss, the mental and physical costs, time loss, and sometimes limb loss or death [16].…”

Section: Introductionmentioning

confidence: 99%

Does Preoperative Antimicrobial Prophylaxis Influence the Diagnostic Potential of Periprosthetic Tissues in Hip or Knee Infections?

Bedenčič

Kavčič

Faganeli

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Undiagnosed low-grade prosthetic joint infections (PJI) are recognized as an important reason for early failure of presumably aseptic revisions. Preoperatively administered antimicrobial prophylaxis reduces the incidence of PJI but it may reduce the sensitivity of microbiologic periprosthetic tissue cultures and consequently increase the incidence of undiagnosed septic prosthetic joint failures, which can lead to catastrophic serial revisions. Questions/purposes We wished to determine whether administration of preoperative antibiotics decreases the likelihood of diagnosing PJI in patients undergoing revision hip or knee arthroplasty in whom infection is suspected. Methods We prospectively enrolled and evaluated 40 patients (29 with THAs and 11 with TKAs) who met the following inclusion criteria: older than 18 years, with suspected PJI of unknown cause, undergoing surgical revision. After arthrotomy, three tissue samples were obtained for microbiologic analysis and diagnosis, and antimicrobial prophylaxis (cefazolin 2 g intravenously) then was administered. Later during the procedure, but before débridement and irrigation, the second set of three tissue samples was obtained from the same surgical area and was cultured. Tissue concentration of prophylactic antibiotic was verified with the second set of samples. A positive culture result was defined as one or more positive cultures (growth on agar at or before 14 days). We then compared the yield on the microbiologic cultures obtained before administration of antibiotics with the yield on the cultures obtained after antibiotics were administered. An a Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the Valdoltra Orthopaedic Hospital, Ankaran, Slovenia. priori analysis was performed; with the numbers available, we had 98% power to detect a difference in diagnostic sensitivity of 33%. Results With the numbers available, we found no difference in the likelihood that an infection would be diagnosed between the samples obtained before and after administration of antimicrobial prophylaxis...

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Prosthesis Failure Within 2 Years of Implantation Is Highly Predictive of Infection

Cited by 100 publications

References 26 publications

Improved Diagnosis of Orthopedic Implant-Associated Infection by Inoculation of Sonication Fluid into Blood Culture Bottles

Improved Diagnosis of Orthopedic Implant-Associated Infection by Inoculation of Sonication Fluid into Blood Culture Bottles

Implantable Device-Related Infection

Does Preoperative Antimicrobial Prophylaxis Influence the Diagnostic Potential of Periprosthetic Tissues in Hip or Knee Infections?

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