Accurate and early diagnosis of orthopedic device‐related infection by microbial heat production and sonication

Borens, Olivier; Yusuf, Erlangga; Steinrücken, Julia; Trampuž, Andrej

doi:10.1002/jor.22419

Cited by 50 publications

(45 citation statements)

References 15 publications

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“…The identification of the causative microorganisms solely by tissue cultures has been unhelpful in a large proportion of cases, particularly in those with previous use of antibiotics (10). For this reason, several researchers have applied a sonication (low-intensity ultrasound) technique to displace microorganisms from the surface of removed prosthetic devices, and they eventually were able to demonstrate an increase in the rate of etiological diagnosis compared to that with periprosthetic tissue cultures (11,(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Since skincontaminating bacteria produce many osteosynthesis infections, comparing the sonication results of prosthetic joint infection to those of fracture fixation infections is not an easy task.…”

Section: Discussionmentioning

confidence: 99%

“…Since skincontaminating bacteria produce many osteosynthesis infections, comparing the sonication results of prosthetic joint infection to those of fracture fixation infections is not an easy task. Few of these previous studies evaluated the role of sonication in the microbiological diagnosis of osteosynthesis infections (17,20,22,26,27). Holinka et al (20) sonicated only six osteosynthesis devices and therefore could not draw any conclusions regarding the advantage of sonication compared to conventional techniques (20).…”

Section: Discussionmentioning

confidence: 99%

“…In fact, the diagnosis of implant-associated bone and soft tissue infections in trauma patients is not easy to perform, as clinical examination may not be helpful, inflammatory blood markers are usually unhelpful, and imaging tests are nonspecific (6,7). Therefore, we applied to our data a definition from previous studies that analyzed the role of sonication in orthopedic implant-associated infections, including in osteosyntheses (14,15,20,22,26). Also, some technical aspects for sonication still need to be standardized, including the number of microorganisms required to be defined as an infection, the total volume of Ringer's solution for containers, especially for small implants, such as screws and small plates, and concentration steps (15).…”

Section: Discussionmentioning

confidence: 99%

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Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

et al. 2014

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Previous studies have shown that sonication fluid cultures from removed orthopedic devices improved the microbiological diagnosis of orthopedic implant-associated infections; however, few of these investigations have applied sonication to the removed fracture fixation devices to evaluate its utility for the diagnosis of osteosynthesis-associated infection (OAI). We compared sonication fluid to conventional tissue cultures from 180 subjects with different sizes of plates and screws (n ‫؍‬ 156), spinal implants (n ‫؍‬ 26), and intramedullary nails (n ‫؍‬ 3), of whom 125 and 55 subjects had OAI and noninfected osteosynthesis (NIO), respectively. The sensitivity for detecting OAI was 90.4% for sonication fluid culture and 56.8% for periprosthetic tissue cultures (P < 0.05), and the specificities were 90.9% and 96.4%, respectively. Sonication fluid culture detected more pathogens than peri-implant tissue culture (113 versus 71; P < 0.001), while polymicrobial infections were diagnosed by sonication fluid cultures and tissue cultures in 20.8% and 8% (P < 0.001), respectively. Microbiological diagnosis was achieved exclusively by sonication fluid cultures for 47 (90.4%) subjects, and among them, 18 (38.3%) had previously received antibiotics, whereas in five (9.6%) infected subjects, tissue culture was positive and the sonication fluid culture was negative. Among 39 (31.2%) OAI cases receiving antibiotics, the identification of the organisms occurred in 38.5% and 82.1% of the tissue and sonication fluid cultures, respectively (P < 0.049). We demonstrated that sonication fluid culture from removed osteosyntheses has the potential for improving the microbiological diagnosis of OAI. Due to the increasing occurrence of trauma and injuries, particularly those associated with road traffic accidents (1), surgical implantation of orthopedic devices for fracture fixations (or osteosynthesis), including intramedullary nails, different size plates, screws, and external fixation pins, have increased. Indeed, the acute management of bone fractures in trauma patients has evolved steadily, and there is an expanded indication for osteosynthesis, with the aim of early stabilization of the fractures. Depending upon the physiological condition of the patient, especially those with unstable polytrauma and significant lower extremity injuries, surgeons must choose the less aggressive external fixation first step for fracture stabilization (2). Once the adequate local wound debridement is ensured, which includes the removal of all dead and infected tissues and the stabilization of the systemic clinical condition of the patient, secondary major osteosynthesis is then performed with either plates and screws or intramedullary nails (3).Following orthopedic surgery, secondary soft tissue and implant-associated bone infections are still the most important negative aspects and limiting factors of success, leading to significant morbidity, including delayed bone union or nonunion, multiple additional debridement, or even amputation. Wound contamin...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

et al. 2014

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“…A meticulous treatment plan is warranted to provide the patient the best possibilities for a successful outcome. PCR-based methods as well as sonication may be valuable tools in the proper diagnostics of an implant-related infection (Borens et al 2013). Fracture union should be the most important aspect when deciding the proper treatment path.…”

Section: Future Aspectsmentioning

confidence: 99%

Complications in ankle fracture surgery

Ovaska¹

2015

Acta Orthop

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“…Previous studies have shown that liquid cultures seem to provide better conditions to sessile bacterial growth than solid media (9,10). As already shown in previous studies addressing OIAI and prosthetic joint infection, Gram-positive bacteria were the most common sessile pathogens isolated in SC (60.6%) and SMF (72.7%), followed by Gram-negative bacilli, which have been increasingly identified among subjects presenting OIAIs (3,11). Our study had limitations, including the small sample size analyzed and the lack of a universally accepted clinical diagnosis of OIAI.…”

mentioning

confidence: 63%

Concentration of Sonication Fluid through Centrifugation Is Superior to Membrane Filtration for Microbial Diagnosis of Orthopedic Implant-Associated Infection

et al. 2016

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Microbial identification of orthopedic implant-associated infections using sonication fluid (SF) submitted to a concentration step by membrane filtration (SMF) was compared with the standard centrifugation (SC) method. Among 33 retrieved infected implants, sonication identified microorganisms in 26 (78.8%). The sensitivity of SC was higher than that of SMF (78.8% versus 30.3%; P < 0.001). Several authors have applied a sonication technique as an adjunctive diagnostic tool to increase the identification of causative agents of different orthopedic implant-associated infections (OIAIs) (1-3). However, sonication may also give false-negative results in at least 10% to 20% of cases when applying only phenotypic methods (4). We hypothesized that submitting the sonication fluid (SF) to a validated method of sample concentration, such as membrane filtration, in which the total volume of SF is submitted to filtration through a membrane filter with a pore size smaller than the bacterial size, would improve the microbial diagnosis of orthopedic implant-associated infection.We prospectively included 35 patients who underwent surgical removal of infected prosthetic joints (knee and hip) and internal fracture-fixation devices, including different sizes of plates and screws, between March 2013 and July 2014 at the orthopedic department of the Santa Casa de São Paulo School of Medical Sciences (Brazil). Subjects were excluded when clear contamination occurred during implant removal, transportation, or processing in the microbiology laboratory or if membrane obstruction was observed. Subject demographics, type of orthopedic implants, and indication for surgical removal were recorded. The study protocol was reviewed and approved by the Institutional Review Board. OIAI was diagnosed if at least one of the following criteria was present: open wound exposing fractured bone and/or osteosynthesis and prosthetic joint devices with gross evidence of purulence, intraoperative tissue with visible purulence, presence of a draining fistula communicating with the internal implant, and/or acute inflammation in intraoperative osteosynthesis/prosthetic joint tissue detected by histopathology (3).In the operating room, surgically removed orthopedic implants were placed in sterile polyethylene containers to which 650 ml of Ringer solution was added and then sealed with an airtight cover for transportation. The time limit for processing samples was 6 h. In the microbiology laboratory, containers with the retrieved implants were vortexed for 30 s at maximum power using the Vortex Genie 2 (Scientific Industries, Inc., Bohemia, NY, USA) and then sonicated (BactoSonic ultrasound bath; Bandelin GmbH, Berlin, Germany) for 5 min at a frequency of 40 Ϯ 2 kHz and power density of 0.22 Ϯ 0.04 W/cm 2 , followed by an additional 30 s of vortexing.In order to concentrate the SF, centrifugation was performed with 50-ml aliquots at 2,500 ϫ g for 5 min. The supernatant was aspirated, leaving 0.5 ml (100-fold concentration). Aliquots of 0.1 ml of concentrated SF w...

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Accurate and early diagnosis of orthopedic device‐related infection by microbial heat production and sonication

Cited by 50 publications

References 15 publications

Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

Complications in ankle fracture surgery

Concentration of Sonication Fluid through Centrifugation Is Superior to Membrane Filtration for Microbial Diagnosis of Orthopedic Implant-Associated Infection

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