Microbiological diagnosis of polymicrobial periprosthetic joint infection revealed superiority of investigated tissue samples compared to sonicate fluid generated from the implant surface

Abstract

In the microbiological diagnosis of periprosthetic joint infection (PJI), there is much discussion about the methodology of obtaining proper specimens, the processing technique, and suitable culture media. This retrospective study was conducted to analyse the accuracy of our culture techniques. Methods: Tissue samples and components from 258 patients after revision arthroplasty of the hip, knee, and shoulder were investigated, and the results of tissue cultures (TC) were compared to those of sonicate fluid cultures (SFC). Furthermore, an evaluation was performed of the influence of different culture media on the detection rate. Results: PJI was confirmed in 186 patients. The overall sensitivity of TC was no different to that of SFC (91.3% vs 90.8%, P = 1). In 153 cases (82.3%), TC and SFC showed concordant positive results. Results were discordant in 33 cases (17.7%). When differentiated according to the type of infection, TC showed significantly better results than SFC in detecting polymicrobial infections (97.0% vs 67.0%, P = 0.004). There were also significant differences between the culture media regarding the yield of microorganisms. Conclusions: TC was more effective in detecting co-infections. The best results were obtained using both TC and SFC. The choice of culture media has a significant influence on the quality of results.

Challenges in the Microbiological Diagnosis of Implant-Associated Infections: A Summary of the Current Knowledge

“…These findings were further confirmed by a recent study showing higher sensitivity of TC than sonication (94.3% vs. 80.5%), although a certain diagnosis of PJIs was only possible throughout SFC in a not-negligible rate of cases (9%) (Hoekstra et al, 2020). Even more recently, Rieber et al (2021) showed that the overall sensitivity of TC and SFC was similar (91.3% vs. 90.8%, respectively) and, surprisingly, TC showed significantly better results than SFC in detecting polymicrobial infections (97.0% vs. 67.0%).…”

“…However, there has been debate about the optimal length of incubation of PJI samples and systematic assessment of culture duration has not been defined yet (Virolainen et al, 2002;Neut et al, 2003;Williams et al, 2004;Nelson et al, 2005;Parvizi et al, 2006;Trampuz and Widmer, 2006;Trampuz et al, 2007;Piper et al, 2009;Holinka et al, 2011;Esteban et al, 2013;Portillo et al, 2013Portillo et al, , 2014Shen et al, 2015;Renz et al, 2018). Several authors have recommended incubation for 10-14 days in order to improve the sensitivity (Butler-Wu et al, 2011;Minassian et al, 2014;Portillo et al, 2015;Hoekstra et al, 2020;Rieber et al, 2021) whereas only one study, to our knowledge, proposed 30 days of incubation to detect anaerobic bacteria (Esteban et al, 2008). A 2week incubation period seems to be optimal since early detected species (mostly Staphylococci) emerge predominantly during the first week, whereas late-detected agents (mostly Cutibacterium species, formerly known as Propionibacterium spp.)…”

“…Nevertheless, Rieber et al (2021) showed that SFC-BCBs is less efficient if anaerobes are the suspected cause of infection and therefore recommended caution when dealing with anaerobes possibly causing PJIs until a gold standard for laboratory handling of anaerobes has been established. Furthermore, the same authors showed that using inoculation into thioglycollate broth was better than into BCBs (Rieber et al, 2021).…”

Evaluation of two different semi-automated homogenization techniques in microbiological diagnosis of periprosthetic joint infection: disperser vs. bead milling method

“…All specimens were also incubated for fourteen days using brain-heart infusion broth (BHI, Oxoid, Basingstoke, Hampshire, United Kingdom) and thioglycollate broth medium additionally incorporated with liver digest and finally supplemented with hemin and horse serum (LT, SIFIN, Berlin, Germany). For more details about this approach, see the literature [ 2 , 3 ]. As an adjunct, the results of all investigated prostheses and components had no influence on the study and are therefore not discussed in more detail here.…”

“…Unfortunately, there are still no standard procedures for processing or cultivation. We have recently published data on the significance of culture media for diagnostics in PJI [ 2 , 3 ].…”