Sonication as a Diagnostic Approach Used to Investigate the Infectious Etiology of Prosthetic Hip Joint Loosening

Abstract

The purpose of the study was to evaluate the usefulness of sonication for the diagnosis of prosthetic joint infections (PJIs) by its comparison with periprosthetic tissues (PTs) and synovial fluid (SV-F) cultures. The study groups included 54 patients undergoing exchange of total hip prostheses for so called "aseptic" loosening occurring without clinical manifestations of an accompanying PJI and 22 patients who developed a sinus tract communicating with the prosthesis which was indicative of an ongoing infectious process. Significant positive culture results were obtained among 10 (18.5%) patients with "aseptic" implant failure and in 18 (81.8%) patients who developed a sinus tract. Sonicate-fluid (S-F) yielded bacterial growth in all culture-positive patients with "aseptic" loosening vs. 15 patients with presumed PJIs. There was a concordance in terms of bacterial species isolated from S-F and conventional cultures from individual patients. Coagulase-negative staphylococci were isolated most frequently. Sensitivity of sonication (75%) exceeded that estimated for PTs (69%) and SV-F (45%) cultures. We conclude that identification of causative agents of PJIs which is critical to further therapeutic decisions is aided by the combination of sonication and conventional culture.

Diagnostik der periprothetischen Infektion

“…Gemäß MSIS [ 76 ], IDSA [ 58 ], International Consensus Meeting [ 61 ] und EBJIS [ 68 ] beweist das Vorhandensein einer Fistel, die mit einer Prothese kommuniziert, die periprothetische Infektion [ 9 , 80 ].…”

Prosthetic joint infection development of an evidence-based diagnostic algorithm

“…Two studies dealing with microbiological cultures of patients with a sinus tracts were included; however, a pathogen was not identified in all cases (Table 4 ). Bogut et al calculated a sensitivity of 0.82 (0.66–0.98) and a specificity of 1.0 (1.0–1.0; LoE II) [ 75 ]. Trampus et al identified a positive microbiological culture in all cases after sonication and described a sensitivity of 1.0 and a specificity of 1.0 (LoE I) [ 76 ].…”

Staphylococcus epidermidis: how to turn from commensal to be a pathogen lifestyle

“…It was most extensively studied for staphylococci, especially for S. aureus as well as S. epidermidis. 43 SCVs were recorded as being <1 mm in size (less than 1/10 of the normal cell size), with reduced pigmentation and haemolytic activity as described in literature. 43,44 The tiny size of SCVs on solid agar is often due to auxotrophy for haemin and/or menadione, two compounds involved in the biosynthesis of electron transport chain components, which is associated with defects in electron transport and, consequently, altered membrane potential.…”

“…43 SCVs were recorded as being <1 mm in size (less than 1/10 of the normal cell size), with reduced pigmentation and haemolytic activity as described in literature. 43,44 The tiny size of SCVs on solid agar is often due to auxotrophy for haemin and/or menadione, two compounds involved in the biosynthesis of electron transport chain components, which is associated with defects in electron transport and, consequently, altered membrane potential. The abnormal membrane potential, in turn, may confer on these variants innate resistance to aminoglycosides, since the ability of these antibiotics to gain access to intracellular target sites depends on the proton motive force.…”

“…44,45 Additionally, it was proved that in vitro experiment using menadione auxotrophs of S. aureus and haemin auxotrophs of S. epidermidis 46 resulted in the upregulation of alternative sigma factor B, which plays a central role in the augmentation of icaADBC expression and PIA production. 43,47…”