Microbiological diagnosis of intramedullary nailing infection: comparison of bacterial growth between tissue sampling and sonication fluid cultures

Finelli, Carlos Augusto; Silva, Cely Barreto da; Murça, Maria Aparecida Soares; Reis, Fernando Baldy dos; Miki, Natália; Fernandes, Hélio Jorge Alvachian; Dell’Aquila, Adriana; Salles, Mauro José Costa

doi:10.1007/s00264-020-04771-y

Cited by 10 publications

(3 citation statements)

References 20 publications

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“…Similarly, Khosravi et al, and Fernandes et al, 16 studies agree with the present study, where they reported that S. aureus as the most prevalent isolate followed by P. aeruginosa and Klebsiella species. 16 In contrast, the predominance of S. aureus was also reported by Finelli et al, 17 and confirmed in the review study conducted by Li and Webster. 18 In the present study, the antimicrobial susceptibility pattern of predominant GNB pseudomonas showed 71% susceptibility for meropenem (MRP) followed by 57% to piperacillin and tazobactam (Piptaz), 43% for ciprofloxacin and 43% for amikacin.…”

Section: Discussionsupporting

confidence: 59%

The microbiome of orthopedic implant-associated infections and its correlation with inflammatory markers

Kishor Kumar B,

Ramani C P,

Sudha N

2023

Asian J Med Sci

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Background: Implant site and periprosthetic joint infections (PPJI) are of major concern with tremendous improvement in orthopedic operative procedures. Early diagnosis of infection is the cornerstone for success rate and prevention of implant failure. The need for inflammatory biomarkers followed by culture sensitivity remains inevitable in the diagnosis of infection. Aims and Objectives: The aim is to study the prevalent biofilm-forming pathogens and to correlate with antimicrobial resistance and also to estimate inflammatory markers to predict the presence of PPJI. Materials and Methods: A descriptive cross-sectional study involving 57 patients showing signs of PPJI was evaluated. Clinical samples of these cases were processed, the bacterial pathogens were isolated and bio-film formation was tested. Inflammatory markers C-reactive protein by latex agglutination and interleukin-6 (IL6) by ELISA is determined. Results: A total of 36 bacterial pathogens are isolated, 17% are Gram-positive cocci (GPC) and 46% are Gram-negative bacilli (GNB). Among these, 54% are biofilm producers and pseudomonas species (33%) are predominant. Antibiotic susceptibility studies showed GPC to be highly sensitive to linezolid (100%) and vancomycin (100%). Among GNB, pseudomonal species showed susceptibility of 85%, 57%, and 47% to meropenem, amikacin, and piperacillin–tazobactam, respectively. Acinetobacter is the most resistant isolate. The IL value of 19.5 arrived by the receiver operating curve showed maximum sensitivity and minimal false positivity. Conclusion: Assessing the infection-specific biomarkers like IL6 levels is advantageous in earlier detection of implant site infection and aid in instituting specific antibiotics for the most common implant and PPJI before permanent implant failure and sepsis.

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Section: Discussionsupporting

confidence: 59%

The microbiome of orthopedic implant-associated infections and its correlation with inflammatory markers

Kishor Kumar B,

Ramani C P,

Sudha N

2023

Asian J Med Sci

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“…Currently, TSC is still the mainstay to identify FDRI-associated pathogen, though the sensitivity of TSC remains unsatisfactory, ranging from 43% ( 21 ) to 89% ( 22 ), with most of the reported outcomes around 60% ( 23 ). It is known that TSC outcome is influenced by multiple factors, such as recent surgical intervention and antibiotic use, specimen selections, culture condition, and even the number of tissue samples for culture ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Implant surface culture may be a useful adjunct to standard tissue sampling culture for identification of pathogens accounting for fracture-device-related infection: a within-person randomized agreement study of 42 patients

Jiang

Lin

et al. 2022

ActaO

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Background and purpose: Identification of pathogens causing fracture-device-related infection (FDRI) is always a challenge as the positive rate of standard tissue sampling culture (TSC) remains unsatisfactory. This study evaluates the efficiency of implant surface culture (ISC) as an adjunct to standard TSC for identification of FDRI-associated microorganisms.Patients and methods: Between November 2020 and March 2022, patients diagnosed with FDRI defined by the International Fracture-Related Infection (FRI) Consensus Group, and indicated for implant removal, underwent both methods for bacteria detection. The test order of ISC and TSC was randomly selected for each patient included, as a within-person randomized design. For ISC, the recovered implants were gently covered with tryptic soy agar after rinsing with normal saline twice, and then incubated at 37℃ 5% CO2 for up to 14 days. For TSC, 5 specimens were sampled and sent to the Clinical Laboratory of Southern Medical University Nanfang Hospital, Guangzhou, for culture and identification.Results: 42 consecutive patients were included, with a mean age of 46 years. The most frequent infection site and implant type were the tibia (21 cases) and plates with screws (30 cases), respectively. Altogether 21 patients were found with positive outcomes by both methods, and the identified pathogens were consistent. ISC found an additional 15 patients showing positive results, which were negative by TSC. Furthermore, the mean culture time of ISC was shorter than that of TSC (1.5 days vs. 3.2 days).Interpretation: ISC may be a useful adjunct to TSC for detection of bacteria causing FDRI, with a relatively higher positive rate and a shorter culture time.

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“…diagnosing fracture-related infections were 98% (95% CI, 92% to 99%), 38% (95% CI, 23% to 56%), 1.6 (95% CI, 1.2% to 2.1%), 0.06 (95% CI, 0.01% to 0.30), and 25 (4 to 154), respectively (Table 2; Figure 4). Banousi/2020/Greece [35] Bellova/2019/Germany [36] Fernández-Sampedro/2017/Spain [37] Finelli/2020/Brazil [38] Sebastian/2018/India [39] Tani/2017/Greece [40] Van Diek/2017/Netherlands [41] Vergidis/2011/USA [42] The reported DOR denote that the OR for positive results among persons with fracture-related infections was approximately 25 times higher than the OR for positive results among persons with no infection. The SROC plot showed an area under the curve (AUC) of 84% (95% CI, 81 to 87%) (Figure 5).…”

Section: Risk Of Biasmentioning

confidence: 99%

Accuracy of Tissue and Sonication Fluid Sampling for the Diagnosis of Fracture-Related Infection: Diagnostic Meta-Analysis

Ahmed¹,

Almutairi²,

Alkaseb³

2021

Cureus

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Evidence shows that tissue sample culturing is the gold standard approach for diagnosing fracture-related infection (FRI). Sonication fluid sampling has also been reported to be efficacious and superior to tissue sample culturing with prosthetic joint infection. However, data from the current literature are not enough to validate this hypothesis for FRI. We conducted a meta-analysis to validate the diagnostic accuracy of tissue sample culturing and sonication fluid aspiration and to find which one is superior to the other. An extensive search through the relevant databases was conducted to obtain all the relevant studies. We have included 13 relevant studies, including nine retrospective cohorts and four prospective ones. The overall pooled estimates of sensitivity, specificity, and diagnostic odds ratio (DOR) of tissue sampling culture in diagnosing fracture-related infections were 98% (95% CI, 92% to 99%), 38% (95% CI, 23% to 56%), and 25 (4 to 154), respectively. The overall pooled estimates of sensitivity, specificity, and DOR of sonication fluid sample culture in diagnosing fracture-related infections were 86% (95% CI, 79% to 92%), 98% (95% CI, 93% to 100%), and 353 (78 to 1598), respectively. No significant risk of bias was found regarding the sensitivity and specificity among studies investigating both modalities, however, significant heterogeneity was noticed. Sonication fluid sampling can be used to confirm FRI while tissue sampling can be used to exclude it and both modalities should be combined for obtaining the most accurate outcome.

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Microbiological diagnosis of intramedullary nailing infection: comparison of bacterial growth between tissue sampling and sonication fluid cultures

Cited by 10 publications

References 20 publications

The microbiome of orthopedic implant-associated infections and its correlation with inflammatory markers

The microbiome of orthopedic implant-associated infections and its correlation with inflammatory markers

Implant surface culture may be a useful adjunct to standard tissue sampling culture for identification of pathogens accounting for fracture-device-related infection: a within-person randomized agreement study of 42 patients

Accuracy of Tissue and Sonication Fluid Sampling for the Diagnosis of Fracture-Related Infection: Diagnostic Meta-Analysis

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