Sonication Culture of Antimicrobial Agent-Containing Cement Spacers Removed during Staged Revisions for Arthroplasty Infection

Abstract

Diagnosis of persistent infection at the time of reimplantation for staged revision of infected arthroplasties is challenging. Implant sonication culture for the diagnosis of prosthetic joint infection (PJI) has improved sensitivity compared to standard periprosthetic tissue culture. We report our experience with periprosthetic tissue culture and sonication culture of antimicrobial agent-containing cement spacers (ACSs) collected during second stages of staged revisions for arthroplasty infection. We studied 87 ACSs from 66 patients undergoing two-stage revision arthroplasty for PJI submitted for sonication culture, along with conventional periprosthetic tissue cultures. Two or more positive periprosthetic tissue cultures with the same organism were considered a positive tissue culture. For sonication culture, ≥20 CFU of bacteria per 10 ml of sonicate fluid was considered positive. The sensitivity and specificity of periprosthetic tissue and ACS sonication culture in detecting persistent infection, as well as their association with outcome, were assessed. Persistent infection occurred in 26% of cases. Periprosthetic tissue and sonicate fluid culture had specificities of 96.3 and 100% (P = 0.50), respectively, and sensitivities of 31.6 and 26.3% (P = 1.00), respectively, for the diagnosis of persistent infection. Thirteen subjects deemed not to have persistent infection at time of reimplantation and who had negative periprosthetic tissue and sonicate fluid cultures subsequently developed overt infection. Sonication culture of cement spacers identifies a similar proportion of patients with persistent infection during staged revisions, as detected by periprosthetic tissue cultures; both have low sensitivities to detect persistent infection.

Sonication fluid culture of antibiotic-loaded bone cement spacer has high accuracy to confirm eradication of infection before reimplantation of new prostheses

“…The included studies investigated artificial hip, knee, shoulder, and elbow joints. Three studies [ 17 , 20 , 26 ] are conducted in the USA, and eight [ 19 , 21 , 24 , 26 – 30 ] from Europe. Ten studies [ 17 , 19 , 20 , 24 – 30 ] provided the results of sonication fluid culture from spacers, and one [ 21 ] used PCR analysis of sonication fluid from spacers.…”

“…Results assessing the value of sonication fluid culture of antibiotic-loaded bone cement spacer for diagnosing revision failure as generated from the 10 datasets [ 17 , 19 – 21 , 24 , 26 – 30 ] included in the present meta-analysis showed a sensitivity of 0.31 (95% CI, 0.13 to 0.58), a specificity of 0.94 (95% CI, 0.86 to 0.98), a PLR of 5.37 (95% CI, 2.83 to 10.20), an NLR of 0.73 (95% CI, 0.53 to 0.99), a DOR of 7.38 (95% CI, 3.33 to 16.38), and an AUC of 0.83 (95% CI, 0.79 to 0.86) (Figs. 4 , 5a , and 6a ).…”