Rapid Molecular Microbiologic Diagnosis of Prosthetic Joint Infection

Cazanave, Charles; Greenwood‐Quaintance, Kerryl E.; Hanssen, Arlen D.; Karau, Melissa J.; Schmidt, Suzannah M.; Urena, Eric O. Gomez; Mandrekar, Jayawant N.; Osmon, Douglas R.; Lough, Lindsay E.; Pritt, Bobbi S.; Steckelberg, James M.; Patel, Robin

doi:10.1128/jcm.00335-13

Cited by 165 publications

(145 citation statements)

References 29 publications

(46 reference statements)

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“…Culture-negative OIAI may be due to the use of prior antimicrobial therapy, inadequate diagnostic methods, or the inability of a pathogen to grow with the current available culture methods (18,27,28). In our study, sonication succeeded in significantly reducing the rate of culture-negative OIAI from 41% (by intraoperative tissue culture) to 13%.…”

Section: Discussionmentioning

confidence: 58%

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: 58%

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

Salvadó²,

et al. 2015

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“…Further, various factors, including antibiotic use and specimen contamination, may influence the diagnostic ability of SFC (12,14,16,17). We identified 120 false-negative results from 12 studies.…”

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confidence: 98%

“…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.…”

mentioning

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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confidence: 99%

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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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Microbiology of Bone and Joint Infections

Ryu

Patel²

2015

Bone and Joint Infections

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Rapid Molecular Microbiologic Diagnosis of Prosthetic Joint Infection

Cited by 165 publications

References 29 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

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

Microbiology of Bone and Joint Infections

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