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

Drago, Lorenzo; Vecchi, Elena De; Cappelletti, Laura; Vassena, Christian; Toscano, Marco; Bortolin, Monica; Mattina, Roberto; Romanò, Carlo Luca

doi:10.1007/s10096-015-2416-8

Cited by 19 publications

(7 citation statements)

References 23 publications

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“…Incubation should be a minimum of 5–7 days for aerobic cultures and up to 14 days for anaerobic culture methods. Prolonged incubation is recommended when chronic and delayed infections due to slow-growing microorganisms and anaerobic bacteria, such as Cutibacterium acnes , are suspected, for example with prosthetic shoulder joint infections [21,43,44,45]. Several studies in recent years report the advantages of using blood culture bottles for culture of joint fluid, periprosthetic tissue homogenate and sonication fluid from the prosthesis.…”

Section: Methodsmentioning

confidence: 99%

The World Association against Infection in Orthopaedics and Trauma (WAIOT) procedures for Microbiological Sampling and Processing for Periprosthetic Joint Infections (PJIs) and other Implant-Related Infections

Drago

Clerici

Morelli

et al. 2019

JCM

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While implant-related infections continue to play a relevant role in failure of implantable biomaterials in orthopaedic and trauma there is a lack of standardised microbiological procedures to identify the pathogen(s). The microbiological diagnosis of implant-related infections is challenging due to the following factors: the presence of bacterial biofilm(s), often associated with slow-growing microorganisms, low bacterial loads, previous antibiotic treatments and, possible intra-operative contamination. Therefore, diagnosis requires a specific set of procedures. Based on the Guidelines of the Italian Association of the Clinical Microbiologists (AMCLI), the World Association against Infection in Orthopaedics and Trauma has drafted the present document. This document includes guidance on the basic principles for sampling and processing for implant-related infections based on the most relevant literature. These procedures outline the main microbiological approaches, including sampling and processing methodologies for diagnostic assessment and confirmation of implant-related infections. Biofilm dislodgement techniques, incubation time and the role of molecular approaches are addressed in specific sections. The aim of this paper is to ensure a standardised approach to the main microbiological methods for implant-related infections, as well as to promote multidisciplinary collaboration between clinicians and microbiologists.

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Section: Methodsmentioning

confidence: 99%

The World Association against Infection in Orthopaedics and Trauma (WAIOT) procedures for Microbiological Sampling and Processing for Periprosthetic Joint Infections (PJIs) and other Implant-Related Infections

Drago

Clerici

Morelli

et al. 2019

JCM

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“…CA and MCA plates were incubated for 24 h in CO 2 -enriched and ambient atmosphere, respectively; MSA and SAB plates were incubated aerobically for 48 h. BHI and TH broths were maintained for 15 days at 37°C and checked daily for bacterial growth. 7 When broths became turbid or at the end of the incubation period, aliquots of each broth were plated on CA and Schaedler (only TH broth) agar plates and incubated for 48–72 h in CO 2 -enriched atmosphere and in anaerobiosis, respectively.…”

Section: Methodsmentioning

confidence: 99%

Alpha defensin, leukocyte esterase, C-reactive protein, and leukocyte count in synovial fluid for pre-operative diagnosis of periprosthetic infection

Vecchi

Romanò

Grandi

et al. 2018

Int J Immunopathol Pharmacol

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Synovial fluid analysis for diagnosis of prosthetic joint infections has gained increasing interest in the recent past when markers more specific for these infections than the serum ones have been identified. Despite the important steps forward, identification of a gold standard has not yet been identified. In this study, usefulness of alpha defensin, leukocyte esterase, C-reactive protein (CRP), and white blood cells (WBCs) in synovial fluids alone and in combination for diagnosis of prosthetic joint infection was evaluated. Synovial fluids from 32 infected and 34 not infected patients were analyzed. Sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and receiver-operating characteristic (ROC) curves were calculated for each parameter. Moreover, combination of coupled variables was also evaluated by logistic regression analysis. Sensitivity of alpha defensin, CRP, leukocyte count, and leukocyte esterase were 84.4%, 87.5%, 93.7%, and 93.8%, respectively. Specificity was 91.2% for leukocyte counts, 94.1% for alpha defensin, 97.0% for CRP, and 97.1% for leukocyte esterase. Diagnostic accuracy was 89.4% for alpha defensin, 92.4% for WBC counts and CRP, and 95.5% for leukocyte esterase. No statistical differences were observed in area under the curve (AUC) of the ROC curves of alpha defensin, CRP, and leukocyte counts. Logistic regression analysis applied to a model comprising all the variables showed an AUC higher than AUC of coupled variables. In conclusion, results of this study confirm the high sensitivity and specificity of synovial leukocyte esterase for diagnosis of prosthetic joint infection, also suggesting the need to assess a panel of markers to optimize diagnosis of these infections.

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“…Bacterial culture has 43.5-100% sensitivity and 81.2-100% specificity [88,93,95,104,[117][118][119][120][121][122][123][124][125][126][127][128][129][130][131][132][133]. Most authors recommend an incubation period ranging between 7 and 14 days, with at least five culture samples to confirm positivity [134]. Bacterial culture is limited by previous or ongoing antimicrobial therapy, which should be discontinued at least 2 weeks before sampling [96,[135][136][137].…”

Section: Statementsmentioning

confidence: 99%

Diagnosis of peripheral bone and prosthetic joint infections: overview on the consensus documents by the EANM, EBJIS, and ESR (with ESCMID endorsement)

et al. 2019

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Objectives Peripheral bone infection (PBI) and prosthetic joint infection (PJI) are two different infectious conditions of the musculoskeletal system. They have in common to be quite challenging to be diagnosed and no clear diagnostic flowchart has been established. Thus, a conjoined initiative on these two topics has been initiated by the European Society of Radiology (ESR), the European Association of Nuclear Medicine (EANM), the European Bone and Joint Infection Society (EBJIS), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The purpose of this work is to provide an overview on the two consensus documents on PBI and PJI that originated by the conjoined work of the ESR, EANM, and EBJIS (with ESCMID endorsement). Methods and resultsAfter literature search, a list of 18 statements for PBI and 25 statements for PJI were drafted in consensus on the most debated diagnostic challenges on these two topics, with emphasis on imaging. Conclusions Overall, white blood cell scintigraphy and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities for the diagnosis of PBI and PJI. However, the choice of which advanced diagnostic modality to use first depends on several factors, such as the benefit for the patient, local experience of imaging Electronic supplementary material The online version of this article

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

Cited by 19 publications

References 23 publications

The World Association against Infection in Orthopaedics and Trauma (WAIOT) procedures for Microbiological Sampling and Processing for Periprosthetic Joint Infections (PJIs) and other Implant-Related Infections

The World Association against Infection in Orthopaedics and Trauma (WAIOT) procedures for Microbiological Sampling and Processing for Periprosthetic Joint Infections (PJIs) and other Implant-Related Infections

Alpha defensin, leukocyte esterase, C-reactive protein, and leukocyte count in synovial fluid for pre-operative diagnosis of periprosthetic infection

Diagnosis of peripheral bone and prosthetic joint infections: overview on the consensus documents by the EANM, EBJIS, and ESR (with ESCMID endorsement)

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