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

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0252322
Author(s):  
Taiana Cunha Ribeiro ◽  
Emerson Kiyoshi Honda ◽  
Daniel Daniachi ◽  
Ricardo de Paula Leite Cury ◽  
Cely Barreto da Silva ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Diagnostic Criteria ◽  
Gold Standard ◽  
Joint Infection ◽  
Clinical Criterion ◽  
Tissue Cultures ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
The Impact ◽  
Sonication Culture

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).

scholarly journals Sonication Culture of Antimicrobial Agent-Containing Cement Spacers Removed during Staged Revisions for Arthroplasty Infection

2018 ◽  
Vol 57 (2) ◽  
Author(s):  
Eric Gomez-Urena ◽  
Rafael J. Sierra ◽  
Kerryl E. Greenwood-Quiantance ◽  
Melissa J. Karau ◽  
James M. Steckelberg ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Antimicrobial Agent ◽  
Persistent Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Similar Proportion ◽  
Tissue Cultures ◽  
Periprosthetic Tissue ◽  
Prosthetic Joint ◽  
Sonication Culture

ABSTRACT Diagnosis of persistent infection at the time of reimplantation for staged revision of infected arthroplasties is challenging. Implant sonication culture for the diagnosis of prosthetic joint infection (PJI) has improved sensitivity compared to standard periprosthetic tissue culture. We report our experience with periprosthetic tissue culture and sonication culture of antimicrobial agent-containing cement spacers (ACSs) collected during second stages of staged revisions for arthroplasty infection. We studied 87 ACSs from 66 patients undergoing two-stage revision arthroplasty for PJI submitted for sonication culture, along with conventional periprosthetic tissue cultures. Two or more positive periprosthetic tissue cultures with the same organism were considered a positive tissue culture. For sonication culture, ≥20 CFU of bacteria per 10 ml of sonicate fluid was considered positive. The sensitivity and specificity of periprosthetic tissue and ACS sonication culture in detecting persistent infection, as well as their association with outcome, were assessed. Persistent infection occurred in 26% of cases. Periprosthetic tissue and sonicate fluid culture had specificities of 96.3 and 100% (P = 0.50), respectively, and sensitivities of 31.6 and 26.3% (P = 1.00), respectively, for the diagnosis of persistent infection. Thirteen subjects deemed not to have persistent infection at time of reimplantation and who had negative periprosthetic tissue and sonicate fluid cultures subsequently developed overt infection. Sonication culture of cement spacers identifies a similar proportion of patients with persistent infection during staged revisions, as detected by periprosthetic tissue cultures; both have low sensitivities to detect persistent infection.

scholarly journals Comparison of Diagnostic Accuracy of Periprosthetic Tissue Culture in Blood Culture Bottles to That of Prosthesis Sonication Fluid Culture for Diagnosis of Prosthetic Joint Infection (PJI) by Use of Bayesian Latent Class Modeling and IDSA PJI Criteria for Classification

2018 ◽  
Vol 56 (6) ◽  
pp. e00319-18 ◽  
Author(s):  
Qun Yan ◽  
Melissa J. Karau ◽  
Kerryl E. Greenwood-Quaintance ◽  
Jayawant N. Mandrekar ◽  
Douglas R. Osmon ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Blood Culture ◽  
Gold Standard ◽  
Latent Class ◽  
Joint Infection ◽  
Periprosthetic Tissue ◽  
Prosthetic Joint ◽  
Latent Class Modeling ◽  
Sonication Culture ◽  
Fluid Culture

ABSTRACT We have previously demonstrated that culturing periprosthetic tissue in blood culture bottles (BCBs) improves sensitivity compared to conventional agar and broth culture methods for diagnosis of prosthetic joint infection (PJI). We have also shown that prosthesis sonication culture improves sensitivity compared to periprosthetic tissue culture using conventional agar and broth methods. The purpose of this study was to compare the diagnostic accuracy of tissue culture in BCBs (subsequently referred to as tissue culture) to prosthesis sonication culture (subsequently referred to as sonicate fluid culture). We studied 229 subjects who underwent arthroplasty revision or resection surgery between March 2016 and October 2017 at Mayo Clinic in Rochester, Minnesota. Using the Infectious Diseases Society of America (IDSA) PJI diagnostic criteria (omitting culture criteria) as the gold standard, the sensitivity of tissue culture was similar to that of the sonicate fluid culture (66.4% versus 73.1%, P = 0.07) but was significantly lower than that of the two tests combined (66.4% versus 76.9%, P < 0.001). Using Bayesian latent class modeling, which assumes no gold standard for PJI diagnosis, the sensitivity of tissue culture was slightly lower than that of sonicate fluid culture (86.3% versus 88.7%) and much lower than that of the two tests combined (86.3% versus 99.1%). In conclusion, tissue culture in BCBs reached sensitivity similar to that of prosthesis sonicate fluid culture for diagnosis of PJI, but the two tests combined had the highest sensitivity without compromising specificity. The combination of tissue culture in BCBs and sonicate fluid culture is recommended to achieve the highest level of microbiological diagnosis of PJI.

scholarly journals Sonication versus Tissue Sampling for Diagnosis of Prosthetic Joint and Other Orthopedic Device-Related Infections

2018 ◽  
Vol 56 (12) ◽  
Author(s):  
Maria Dudareva ◽  
Lucinda Barrett ◽  
Mel Figtree ◽  
Matthew Scarborough ◽  
Masanori Watanabe ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Relative Yield ◽  
Tissue Samples ◽  
Orthopedic Device ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Tissue Specimens ◽  
Sonication Culture ◽  
Culture Yield

ABSTRACTCurrent guidelines recommend collection of multiple tissue samples for diagnosis of prosthetic joint infections (PJI). Sonication of explanted devices has been proposed as a potentially simpler alternative; however, reported microbiological yield varies. We evaluated sonication for diagnosis of PJI and other orthopedic device-related infections (DRI) at the Oxford Bone Infection Unit between October 2012 and August 2016. We compared the performance of paired tissue and sonication cultures against a “gold standard” of published clinical and composite clinical and microbiological definitions of infection. We analyzed explanted devices and a median of five tissue specimens from 505 procedures. Among clinically infected cases the sensitivity of tissue and sonication culture was 69% (95% confidence interval, 63 to 75) and 57% (50 to 63), respectively (P< 0.0001). Tissue culture was more sensitive than sonication for both PJI and other DRI, irrespective of the infection definition used. Tissue culture yield was higher for all subgroups except less virulent infections, among which tissue and sonication culture yield were similar. The combined sensitivity of tissue and sonication culture was 76% (70 to 81) and increased with the number of tissue specimens obtained. Tissue culture specificity was 97% (94 to 99), compared with 94% (90 to 97) for sonication (P= 0.052) and 93% (89 to 96) for the two methods combined. Tissue culture is more sensitive and may be more specific than sonication for diagnosis of orthopedic DRI in our setting. Variable methodology and case mix may explain reported differences between centers in the relative yield of tissue and sonication culture. Culture yield was highest for both methods combined.

scholarly journals Multidrug-Resistant Gram-Negative bacilli Prosthetic Joint Infection: A Worrisome Scenario

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S97-S97
Author(s):  
Taiana Ribeiro ◽  
Giselle Klautau ◽  
Mauro Salles ◽  
Keyword(s):  
Joint Infection ◽  
Multidrug Resistant ◽  
Adult Patients ◽  
Tissue Cultures ◽  
Knee Prostheses ◽  
Coagulase Negative Staphylococci ◽  
Gram Negative ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Fluid Culture

Abstract Background The spectrum of the microbial etiology of prosthetic joint infections (PJIs) is changing, with a higher occurrence of Gram-negative bacilli (GNB) nowadays. In Latine America, GNB infections are usually caused by strains that produce multiple resistance mechanisms, making antimicrobial treatment increasingly difficult, especially for these biofilm-associated infections. We aimed to demonstrate the higher frequency of PJIs caused by GNB. Methods We performed a retrospective observational study with adult patients with a diagnosis of knee and hip PJIs. Patients included were submitted to an exchange of total hip and knee prostheses between September 2010 and December 2016, in two brazilian hospitals. It was included only patients with microbial diagnosis performed using either sonication fluid cultures of retrieved implant and conventional tissue cultures of periprosthetic tissues. The Infectious Disease Society of America (IDSA) definition was used to establish the diagnosis of PJIs. Multidrug-resistant (MDR) organisms were defined as acquired resistance to at least one agent in three or more antimicrobial categories. Results Were included 130 adult patients with a median age of 65.5 years, in which 60% were female. Infected hip arthroplasty was more frequent than knee infections (69% vs. 31%) and 61% were classified as late infection according to Zimmerli’s classification. One hundred twenty-three microorganisms were isolated on the tissue and sonication fluid culture. Despite the Coagulase-negative Staphylococci was the predominant microorganism (35%), Gram-negative bacilli had an expressive frequency of 30% of positivity on culture. Amongst them, 23% showed resistance to carbapenens and 38% were MDR-bacteria. The predominant microorganism was Pseudomonas spp., followed by Enterobacter spp., Acinetobacter spp., Escherichia coli, Stenotrophomonas maltophilia and Klebsiella pneumoniae, Proteus spp. and Serratia marcescens. There was no statistical difference on the resistance profile of the GNB isolated on tissue and sonicate fluid culture. Conclusion We have shown an alarming high frequency of MDR-Gram-negative bacilli PJIs in two Brazilian centers, performing microbial diagnosis using sonication and tissue cultures. Disclosures All authors: No reported disclosures.

scholarly journals Heterogeneity of Staphylococcus epidermidis in prosthetic joint infections: Time to reevaluate microbiological criteria?

2021 ◽  
Author(s):  
Micael Widerstrom ◽  
Marc Stegger ◽  
Anders Johansson ◽  
Bharat Kumar Gurram ◽  
Anders Rhod Larsen ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Staphylococcus Epidermidis ◽  
Joint Infection ◽  
Antibiotic Resistance Gene ◽  
Whole Genome Sequence ◽  
Clonal Variation ◽  
Whole Genome ◽  
Coagulase Negative Staphylococci ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Prosthetic joint infection (PJI) is a feared complication after arthroplasty with Staphylococcus epidermidis as a major pathogen. One diagnostic criteria for PJI diagnosis is the finding of phenotypically identical organisms based on common laboratory tests in two or more periprosthetic microbial cultures. Because of phenotypical variation within a genetic clone, and clonal variation within a phenotype, the criteria may be ambiguous. Here, we investigate the extent of diversity among coagulase-negative staphylococci in PJI and characterize in detail S. epidermidis isolates from these infections. We performed a retrospective cohort study of 62 consecutive patients with PJI caused by coagulase-negative staphylococci (CoNS) in two hospitals in Northern Sweden. From 16 of the patients, two to nine S. epidermidis isolates were available for whole-genome sequence analyses.Hospital-adapted multidrug-resistant genetic clones of S. epidermidis were identified in 40/62 (65%) of the PJIs using a combination of analysis by pulsed-field gel electrophoresis and multiple-locus sequence typing. Whole genome sequencing showed presence of multiple sequence types (STs) in seven (44%) PJIs. Among isolates of the same ST, within-patient phenotypical variation in antibiotic susceptibility and/or whole-genome antibiotic resistance gene content was frequent (11/16, 69%).These results highlight the ambiguity of using phenotypical characterization of S. epidermidis as diagnostic criteria in PJI. The results call for larger systematic studies to determine the frequency of CoNS diversity in PJIs, the implications of such diversity for microbiological diagnostics, and for the therapeutic outcome in patients.

scholarly journals Patient-Related Factors Affecting the Sensitivity of Sonication of Removed Hip and Knee Implants Against Conventional Tissue Cultures for Diagnosis of Prosthetic Joint Infections

2020 ◽  
pp. 1-7
Author(s):  
Panagiotis Lepetsos ◽  
Anastasios Gketsos ◽  
Antonios Kardatos ◽  
Antonios Stylianakis ◽  
Ioannis Giannaris ◽  
...  
Keyword(s):  
Joint Infection ◽  
P Value ◽  
Diabetic Patients ◽  
Tissue Cultures ◽  
Periprosthetic Tissue ◽  
Knee Prostheses ◽  
Factors Affecting ◽  
Primary Osteoarthritis ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Despite its decreasing incidence, prosthesis-related infections remain a research, diagnostic, therapeutic and cost-related problem. Our study aim was to compare the diagnostic accuracy of conventional periprosthetic tissue culture and culture of sonication fluid of the explanted hardware and to investigate the role of patientrelated factors affecting the sensitivity of the sonication method. We investigated 70 patients undergoing revision hip or knee arthroplasty, at our institution. Patients’ medical history and demographic characteristics were recorded. We compared the culture of samples obtained by sonication of explanted hip and knee prostheses with conventional culture of periprosthetic tissue for the microbiological diagnosis of prosthetic-joint infection. Thirty-two patients had septic loosening and 38 aseptic loosening (48 hip prostheses and 22 knee prostheses). The sensitivities of sonication fluid culture and conventional tissue cultures were 81.25% and 56.25%, respectively (p-value = 0.043). The sensitivity of the sonication method was statistically higher in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of primary osteoarthritis (p-values < 0.05). The sonication method has a greater sensitivity than the conventional periprosthetic tissue cultures for the periprosthetic infections, especially in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of primary osteoarthritis.

scholarly journals Do Prosthetic Joint Infections Worsen the Functional Ambulatory Outcome of Patients with Joint Replacements? A Retrospective Matched Cohort Study

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 872
Author(s):  
Isabel Mur ◽  
Marcos Jordán ◽  
Alba Rivera ◽  
Virginia Pomar ◽  
José Carlos González ◽  
...  
Keyword(s):  
Cohort Study ◽  
Joint Infection ◽  
Assistive Device ◽  
Matched Cohort ◽  
Knee Prostheses ◽  
Matched Cohort Study ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Hip Arthroplasties

Objectives: To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. Methods: In a single-hospital retrospectively matched cohort study, each patient with PJI between 2007 and 2016 was matched on age, sex, type of prosthesis and year of implantation with two other patients with uninfected arthroplasties. The definition of a PJI cure included infection eradication, no further surgical procedures, no PJI-related mortality and no suppressive antibiotics. Functional ambulatory status evaluated one year after the last surgery was classified into four simple categories: able to walk without assistance, able to walk with one crutch, able to walk with two crutches, and unable to walk. Patients with total hip arthroplasties (THAs), total knee arthroplasties (TKAs) and partial hip arthroplasties (PHAs) were analysed separately. Results: A total of 109 PJI patients (38 TKA, 41 THA, 30 PHA) and 218 non-PJI patients were included. In a model adjusted for clinically relevant variables, PJI was associated with a higher risk of needing an assistive device for ambulation (vs. walking without aid) among THA (adjusted odds ratio (OR) 3.10, 95% confidence interval (95% CI) 1.26–7.57; p = 0.014) and TKA patients (OR 5.40, 95% CI 2.12–13.67; p < 0.001), and with requiring two crutches to walk or being unable to walk (vs. walking unaided or with one crutch) among PHA patients (OR 3.05, 95% CI 1.01–9.20; p = 0.047). Conclusions: Ambulatory outcome in patients with hip and knee prostheses with postoperative PJI is worse than in patients who do not have PJI.

scholarly journals The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

2019 ◽  
Vol 8 (12) ◽  
pp. 2113 ◽  
Author(s):  
Deroche ◽  
Bémer ◽  
Valentin ◽  
Jolivet-Gougeon ◽  
Tandé ◽  
...  
Keyword(s):  
Joint Infection ◽  
Antimicrobial Treatment ◽  
Microbiological Diagnosis ◽  
Joint Infections ◽  
Time To Positivity ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Two Samples ◽  
The Right ◽  
Polymicrobial Infections

Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.

scholarly journals Is Gram staining still useful in prosthetic joint infections?

2019 ◽  
Vol 4 (2) ◽  
pp. 56-59 ◽  
Author(s):  
Marjan Wouthuyzen-Bakker ◽  
Noam Shohat ◽  
Marine Sebillotte ◽  
Cédric Arvieux ◽  
Javad Parvizi ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Joint Infection ◽  
Individual Case ◽  
Gram Stain ◽  
Reactive Protein ◽  
Joint Infections ◽  
Gram Staining ◽  
Causative Microorganism ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Abstract. Introduction: Staphylococcus aureus is an independent risk factor for DAIR failure in patients with a late acute prosthetic joint infection (PJI). Therefore, identifying the causative microorganism in an acute setting may help to decide if revision surgery should be chosen as a first surgical approach in patients with additional risk factors for DAIR failure. The aim of our study was to determine the sensitivity of Gram staining in late acute S. aureus PJI.Material and methods: We retrospectively evaluated all consecutive patients between 2005-2015 who were diagnosed with late acute PJI due to S. aureus. Late acute PJI was defined as the development of acute symptoms and signs of PJI, at least three months after the index surgery. Symptoms existing for more than three weeks were excluded from the analysis. Gram staining was evaluated solely for synovial fluid.Results: A total of 52 cases were included in the analysis. Gram staining was positive with Gram positive cocci in clusters in 31 cases (59.6%). Patients with a C-reactive protein (CRP) > 150 mg/L at clinical presentation had a significantly higher rate of a positive Gram stain (30/39, 77%) compared to patients with a CRP ≤ 150 mg/L (4/10, 40%) (p=0.02). A positive Gram stain was not related to a higher failure rate (60.6% versus 57.9%, p 0.85).Conclusion: Gram staining may be a useful diagnostic tool in late acute PJI to identify S. aureus PJI. Whether a positive Gram stain should lead to revision surgery instead of DAIR should be determined per individual case.

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