Use of Blood Culture Vial Specimens in Intraoperative Detection of Infection

Levine, Brett R.; Evans, Brian G.

doi:10.1097/00003086-200101000-00030

Cited by 54 publications

(29 citation statements)

References 26 publications

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“…Levine and Evans [10] studied 34 patients, 25 with infected PJIs and nine without infection. Synovial fluid in blood culture flasks was positive in 92% of infections, tissue biopsies in 77%, and swabs in 76%, with a sensitivity of 92%, 46%, and 64% respectively.…”

Section: Discussionmentioning

confidence: 99%

“…They identified more pathogens (62 vs 51) and fewer contaminants (1 vs 11) using blood culture flasks than culturing on agar plates [8]. One previous study comparing SF grown in blood culture vials with tissue and swabs in patients with PJI concluded SF grown in vials had greater sensitivity, specificity, and accuracy than the other two methods [10]. That study, however, included a low number of patients (24, with nine being uninfected) and the authors did not differentiate between acute and chronic PJI.…”

Section: Introductionmentioning

confidence: 99%

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Blood Culture Flasks for Culturing Synovial Fluid in Prosthetic Joint Infections

Font-Vizcarra

García

Martínez-Pastor

et al. 2010

Clinical Orthopaedics &Amp; Related Research

171

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Background Identifying the etiologic microorganism is essential to guide antimicrobial therapy in prosthetic joint infection. Questions/purpose We (1) compared the frequency of positive cultures with synovial fluid inoculated in blood culture flasks (SF) with those of periprosthetic tissues or swabs in traditional cultures from patients with acute and chronic prosthetic joint infections (PJI) and (2) determined the sensitivity, specificity, and predictive values of the three methods. Patients and Methods We retrospectively reviewed 87 patients with PJIs (54 knees, 33 hips) and 63 patients with aseptic loosening (34 knees, 29 hips). Two SF, periprosthetic tissue, and swab samples were taken for culture in all 150 patients except for 14 in whom only one SF fluid sample was obtained. Synovial fluid was inoculated in blood culture flasks and periprosthetic tissue and swab samples in standard media. Positive cultures were identified with standard biochemical procedures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Blood Culture Flasks for Culturing Synovial Fluid in Prosthetic Joint Infections

Font-Vizcarra

García

Martínez-Pastor

et al. 2010

Clinical Orthopaedics &Amp; Related Research

171

View full text Add to dashboard Cite

show abstract

“…Therefore, it is necessary to improve diagnostic techniques in order to achieve a correct final diagnosis that may help surgeons not only to decide the best operative technique, but also to gain insight into the pathogenesis of joint prosthesis loosening. Up to now, there are no tests with high sensitivity and specificity in order to establish the correct preoperative diagnosis of prosthesis loosening, 7 ) have demonstrated that many preoperative aseptic loosening were indeed septic. In these patients, our results showed that intraoperative histology had a low sensitivity (50%).…”

Section: Discussionmentioning

confidence: 99%

Low sensitivity of histology to predict the presence of microorganisms in suspected aseptic loosening of a joint prosthesis

et al. 2006

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Intraoperative histology has a high specificity and sensitivity when a septic prosthesis loosening is suspected. However, its usefulness to predict the presence of microorganisms when aseptic loosening is suspected is not well defined. Intraoperative histology and cultures from periprosthetic tissue of 61 revision arthroplasties performed owing to suspected aseptic loosening were retrospectively reviewed. Frozen sections were evaluated following Mirra's criteria (adapted by Feldman). Culture was considered positive when the same microorganism was isolated in at least two samples. The cultures were positive in 12 cases and coagulasenegative staphylococci were the most common microorganisms (11 cases). In six out of 12 cases (50%), the histology revealed more than five polymorphonuclear leukocytes per high-power field. The sensitivity, specificity, positive and negative predictive value of histology to detect the presence of microorganisms was 50, 81, 40 and 86%, respectively. In conclusion, intraoperative histology using Mirra's criteria had a low sensitivity to predict the presence of microorganisms in samples from suspected aseptic prosthetic loosening.

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“…A diagnostic gain was reported not only for joint aspirate fluids but also for periprosthetic tissues from several single-center studies without preliminary beadmill processing (10)(11)(12)(13)(14)(15)(16).…”

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confidence: 99%

How Many Samples and How Many Culture Media To Diagnose a Prosthetic Joint Infection: a Clinical and Microbiological Prospective Multicenter Study

Bémer¹,

Léger

Tandé

et al. 2016

J Clin Microbiol

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h Although numerous perioperative samples and culture media are required to diagnose prosthetic joint infection (PJI), their exact number and types have not yet been definitely determined with a high level of proof. We conducted a prospective multicenter study to determine the minimal number of samples and culture media required for accurate diagnosis of PJI. Over a 2-year period, consecutive patients with clinical signs suggesting PJI were included, with five perioperative samples per patient. The bacteriological and PJI diagnosis criteria were assessed using a random selection of two, three, or four samples and compared with those obtained using the recommended five samples (references guidelines). The results obtained with two or three culture media were then compared with those obtained with five culture media for both criteria. The times-to-positivity of the different culture media were calculated. PJI was confirmed in 215/264 suspected cases, with a bacteriological criterion in 192 (89%). The PJI was monomicrobial (85%) or polymicrobial (15%). Percentages of agreement of 98.1% and 99.7%, respectively, for the bacteriological criterion and confirmed PJI diagnosis were obtained when four perioperative samples were considered. The highest percentages of agreement were obtained with the association of three culture media, a blood culture bottle, a chocolate agar plate, and Schaedler broth, incubated for 5, 7, and 14 days, respectively. This new procedure leads to significant cost saving. Our prospective multicenter study showed that four samples seeded on three culture media are sufficient for diagnosing PJI. There is still no standard definition of prosthetic joint infection (PJI). Although numerous perioperative samples are needed to diagnose PJI, their optimal number is not yet definitively known. In 1998, Atkins et al., using a mathematical model, demonstrated that five or six perioperative samples, with a cutoff of three or more culture-positive samples, are needed to diagnose PJI with high sensitivity and specificity (1). Recent guidelines still recommend that about five samples should be cultured for optimal diagnosis of PJI (2, 3). Since each tissue specimen is cultured on four to five culture media, a total of 20 to 25 culture media have to be analyzed per patient. The optimal duration of incubation for periprosthetic cultures was extended to 13 or 14 days, especially for Propionibacterium acnes recovery (4, 5). The implementation of 14-day culture incubation in combination with the use of multiple solid and liquid aerobic and anaerobic culture media makes the daily monitoring of PJI by the laboratory very complex, costly, and time-consuming. Moreover, the number of cases of PJI will continue to increase in the coming decades. Forecasts predict that by 2030, the demand for total hip and knee arthroplasties will grow to 4 million in the United States (6). A major economic effect is that device-associated costs are significantly higher than native bone and joint infections, as recently reported (7). Thi...

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Use of Blood Culture Vial Specimens in Intraoperative Detection of Infection

Cited by 54 publications

References 26 publications

Blood Culture Flasks for Culturing Synovial Fluid in Prosthetic Joint Infections

Blood Culture Flasks for Culturing Synovial Fluid in Prosthetic Joint Infections

Low sensitivity of histology to predict the presence of microorganisms in suspected aseptic loosening of a joint prosthesis

How Many Samples and How Many Culture Media To Diagnose a Prosthetic Joint Infection: a Clinical and Microbiological Prospective Multicenter Study

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