The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive

Abstract

Background In the absence of a gold standard criterion for diagnosing prosthetic joint infections (PJI), sonication of the removed implant may provide superior microbiological identification to synovial fluid and peri-implant tissue cultures. The aim of this retrospective study was to assess the role of sonication culture compared to tissue cultures for diagnosing PJI, using different consensus and international guidelines for PJI definition. Methods Data of 146 patients undergoing removal of hip or knee arthroplasties between 2010 and 2018 were retrospectively reviewed. The International Consensus Meeting (ICM-2018), Musculoskeletal Infection Society (MSIS), Infectious Diseases Society of America (IDSA), the European Bone and Joint Infection Society (EBJIS), and a modified clinical criterion, were used to compare the performance of microbiological tests. McNemar´s test and proportion comparison were employed to calculate p-value. Results Overall, 56% (82/146) were diagnosed with PJI using the clinical criteria. Out of these cases, 57% (47/82) tested positive on tissue culture and 93% (76/82) on sonication culture. Applying this clinical criterion, the sensitivity of sonication fluid and tissue cultures was 92.7% (95% CI: 87.1%- 98.3%) and 57.3% (95% CI: 46.6%-68.0%) (p<0.001), respectively. When both methods were combined for diagnosis (sonication and tissue cultures) sensitivity reached 96.3% (95% CI: 91.5%-100%). Sonication culture and the combination of sonication with tissue cultures, showed higher sensitivity rates than tissue cultures alone for all diagnostic criteria (ICM-18, MSIS, IDSA and EBJIS) applied. Conversely, tissue culture provided greater specificity than sonication culture for all the criteria assessed, except for the EBJIS criteria, in which sonication and tissue cultures specificity was 100% and 95.3% (95% CI: 87.8–100%), respectively (p = 0.024). Conclusions In a context where diagnostic criteria available have shortcomings and tissue cultures remain the gold standard, sonication cultures can aid PJI diagnosis, especially when diagnostic criteria are inconclusive due to some important missing data (joint puncture, histology).

Diagnosis of Deep Periprosthetic Infection of the Hip

“…Однако специфичность метода соникации сопоставима со стандартным микробиологическим исследованием: 90% и 100% соответственно [69]. При объединении методов соникации и микробиологического исследования показатель чувствительности составил 96,3% [70].…”

In vitro elution characteristics of antibiotic‐loaded polymethylmethacrylate cement and a calcium sulfate bone substitute using staphylococci isolated from orthopedic implant‐associated infections

“…The sonication of the liquid culture appears to improve the microbiological yield in orthopedic device-related infections. 8,9 Likewise, the treatment of orthopedic infections is also troublesome and difficult to standardize in clinical practice since systemic antimicrobials reach insufficient tissue bone concentrations and in the inner parts of the biofilm. To overcome this limitation, intraoperative administration of antibiotics has the potential to provide remarkably high local concentrations.…”

“…As a result, they identified the etiology of infections in 78.5% of cultures, compared to 60.8% of peri‐implant tissue cultures. The sonication of the liquid culture appears to improve the microbiological yield in orthopedic device‐related infections 8,9 . Likewise, the treatment of orthopedic infections is also troublesome and difficult to standardize in clinical practice since systemic antimicrobials reach insufficient tissue bone concentrations and in the inner parts of the biofilm.…”

Piezoelectric ultrasonic debridement as new tool for biofilm removal from orthopedic implants: A study in vitro

“…Currently, bacteria isolation and identification for diagnosing PJI is performed by means of cultures of synovial fluid and intraoperative periprosthetic tissues; however, diagnosis often fails due to the low sensitivity of this method 25 (about 60%). 26,27 This fact could be due to the protection that the biofilm offers to the pathogens with respect to detection and elimination. 28 In this context, some studies have shown that the sonication of removed implants and the culture of the sonication fluid culture shows a higher sensitivity (about 90%), 26,27 improving the diagnosis of PJI.…”

“…26,27 This fact could be due to the protection that the biofilm offers to the pathogens with respect to detection and elimination. 28 In this context, some studies have shown that the sonication of removed implants and the culture of the sonication fluid culture shows a higher sensitivity (about 90%), 26,27 improving the diagnosis of PJI. The sonication technique relies on two effects of the ultrasound: cavitation and microstreaming.…”