Prolonged incubation time does not increase sensitivity for the diagnosis of implant-related infection using samples prepared by sonication of the implants

Esteban, Jaime; Álvarez-Álvarez, Beatriz; Blanco, Antonio; Fernández-Roblas, R.; Gadea, Ignacio; García-Cañete, Joaquin; Sandoval, Enrique; Valdazo, María

doi:10.1302/0301-620x.95b7.31174

Cited by 37 publications

(16 citation statements)

References 24 publications

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“…Butler-Wu et al suggested that for all periprosthetic specimens, minimal aerobic and anaerobic culture incubation periods of 13 days are highly recommended (29). However, Esteban et al and Schwotzer et al reported that compared with a 7-day incubation period, a 14-day incubation period does not add more positive results for sonicated orthopedic implants (28,33). In this meta-analysis, six studies were cultured anaerobically for 7 days and five studies were cultured anaerobically for 14 days.…”

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confidence: 90%

Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

Zhai

Qin

et al. 2014

J Clin Microbiol

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bThis meta-analysis included 12 studies that evaluated sonication fluid cultures (SFC) for the diagnosis of prosthetic joint infection (PJI). The pooled sensitivity and specificity were 0.80 (95% confidence interval [CI], 0.74 to 0.84) and 0.95 (CI, 0.90 to 0.98), respectively. Subgroup analyses showed that a 14-day anaerobic culture may improve sensitivity, the use of centrifugation or vortexing may improve specificity, and the use of 400 to 500 ml of Ringer's solution for containers may improve sensitivity and specificity. The best SFC cutoff was >5 CFU. In conclusion, SFC has high sensitivity and very high specificity for diagnosing PJI. P rosthetic joint infection (PJI), which occurs in 1 to 12% of surgical cases, is a common catastrophic complication of joint replacement (1-3). Hence, distinguishing PJI from other causes of joint failure, such as metal allergy or aseptic loosening, is important (4). Several tests for diagnosing PJI, including laboratory tests, nuclear medicine detection, rapid molecular tests, histopathology, and microbiologic culture (5-7), have limited sensitivity and specificity, which impedes the differentiation of PJI from other prosthetic failures (3,4,8).Sonication fluid cultures (SFC), which use sonication to dislodge bacteria from the prosthetic surface, have shown promising improvements in sensitivity compared with that for traditional tissue cultures (9). However, the sensitivities (range, 0.67 to 0.91) and specificities (range, 0.72 to 1.0) among studies assessing the diagnostic value of SFC for PJI are inconsistent (9-21). The Infectious Diseases Society of America guidelines suggest a gap in the validation of the diagnostic value of SFC for PJI and request additional higher-level evidence (8). Therefore, we evaluated the detection validity of SFC for PJI to provide further evidence for its clinical use.We searched Medline, EMBASE, and OVID for articles published between January 1990 and August 2013, using the following medical subject headings or free-text words: joint prosthesis, prosthesis infection, septic loosening, aseptic loosening, replacement, or arthroplasty; and sonication, sonicate, or ultrasonicate. We also manually searched the reference lists of eligible studies

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confidence: 90%

Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

Zhai

Qin

et al. 2014

J Clin Microbiol

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“…A recent study states that the use of prolonged incubation times for solid media failed to increase the detection of implant-related infections [5]. Therefore for 250 patients we extended incubation of AC plates.…”

Section: Discussionmentioning

confidence: 99%

“…Typically, the majority of bacterial cultures of tissues and fluids obtained from sterile sites are incubated for 5 days or less [5,6]. Antimicrobial therapy before sampling, slow and fastidious growth of microorganisms and changes in metabolism due to growth in biofilm are among the reasons for a high rate of false negative results of culture [3].…”

Section: Introductionmentioning

confidence: 99%

Prolonging culture to 15 days improves bacterial detection in bone and joint infections

Drago

Vecchi

Cappelletti

et al. 2015

Eur J Clin Microbiol Infect Dis

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Since the optimal incubation period of cultures for diagnosis of bone and joint infections is still a matter of debate, the present study aimed to evaluate the effects of different incubation periods (5 and 15 days) on microbial isolation. Samples from 387 patients with bone and joint infections (including prosthetic ones) were analyzed from March 2012 to February 2014. In 197 patients (51 %) growth was obtained within 48 hrs, while in 124 (32 %) and 66 (17 %) patients cultures yielded positive results within and after 5 days of incubation, respectively. Of 449 microorganisms isolated, 247 grew within 48 hrs, 131 within the first 5 days of incubation while 71 were isolated after 5 days. Staphylococcus aureus was the most frequently isolated pathogen within 48 hrs, while Propionibacteria were prevalently isolated after 5 days of incubation. Interestingly, about 25 % of microorganisms isolated after 5 days of incubation were coagulase-negative staphylococci. Extending incubation period of broth cultures improves isolation rates of pathogens involved in bone and joint infections thus improving management of these infections.

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“…In some cases, the infection is eradicated but it is not possible to retain good joint function, in which case arthrodesis or amputation may be the end result, which is considered as salvage procedure. 6,10,12,18,[23][24][25][26][27][28][29][30][31][32][33] The choice of the best treatment is based on several factors including the characteristics of the patient, the type of germ involved, the duration of symptoms and the condition of bone and soft tissues. Recently Tsukayama et al 34 have proposed a clinical classification with the aim to help the surgeon to make a choice of the appropriate management.…”

Section: Treatment Optionsmentioning

confidence: 99%

The importance of early diagnosis and management in total knee arthroplasty infection

Amendola¹,

Cauli²,

Calabrò³

et al. 2018

MOJOR

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The infection of a knee prosthesis is a serious complication often characterized by a complex and prolonged diagnostic procedure and the treatment of which, even if could gain a healing of the septic process, not always results in a satisfactory functional result. 1 Difficulties in the treatment of a knee prosthetic infection deal with the presence of the prosthesis which acts as a foreign body, feeding the persistence of the infection itself 2. Microorganisms usually considered as nonpathogenic or poorly resistant to common antibiotic therapy could determine the clinical conditions in which the healing can be achieved only with the removal of the prosthetic implant 3. There are particular situations at the base of the onset and persistence of so-called "foreign body" infections: the host organism reacts against biomaterials filling them with a thin film made of proteinaceous material. Some of these proteins have receptors specific for Staphylococcus Aureus and Epidermidis, determining contact that at least initially, is reversible. This condition can become irreversible through the production of a gelatinous substance (exopolysaccharides) by certain bacterial species as coagulase-negative staphylococci (St. Epidermidis, Capitis, Haemolyticus), Enterobacteriaceae, Pseudomonacee, Aciteobacter (Figure 1). Formation of a matrix glycoprotein then acts, defined by Gristina and Costeron, as "glycocalyx". 2 The action of the glycocalyx is manifold: it forms a barrier against antibiotics and inhibits macrophage phagocytosis. 3

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Prolonged incubation time does not increase sensitivity for the diagnosis of implant-related infection using samples prepared by sonication of the implants

Cited by 37 publications

References 24 publications

Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

Prolonging culture to 15 days improves bacterial detection in bone and joint infections

The importance of early diagnosis and management in total knee arthroplasty infection

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