Sonication of Explanted Prosthetic Components in Bags for Diagnosis of Prosthetic Joint Infection Is Associated with Risk of Contamination

Trampuž, Andrej; Piper, Kerryl E.; Hanssen, Arlen D.; Osmon, Douglas R.; Cockerill, Franklin R.; Steckelberg, James M.; Patel, Robin

doi:10.1128/jcm.44.2.628-631.2006

Cited by 188 publications

(163 citation statements)

References 12 publications

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“…There were 17 patients allocated to the infection group. The criteria for inclusion in this group were a positive peri-prosthetic tissue culture obtained during the revision surgery or open biopsy of the hip, acute inflammation as seen on histological examination by a clinical pathologist (TH) of either frozen sections of peri-prosthetic tissue, or fixed tissues, and visibly purulent synovial fluid in the joint or the area surrounding the prosthesis, according to the criteria of Trampuz et al 3 The noninfection group comprised 29 patients, in whom none of the diagnostic criteria for infection were present, and who had no more than five neutrophils in any high-powered field on frozen section. 4 Of the 17 patients in the infection group, there were ten men and seven women, with a mean age at operation of 57 years (38 to 78).…”

Section: Methodsmentioning

confidence: 99%

Diagnosis of peri-prosthetic infection at the hip using triple-phase bone scintigraphy

Nagoya

Kaya

Sasaki

et al. 2008

The Journal of Bone and Joint Surgery. British volume

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We evaluated triple-phase bone scintigraphy in the differential diagnosis of peri-prosthetic infection in 46 patients with a total hip replacement or bipolar hemiarthroplasty who were due for revision surgery. There were 18 men and 28 women, with a mean age at operation of 64.6 years (28 to 81). We defined peri-prosthetic infection as an increased uptake of radioisotope in all the phases of triple-phase bone scintigraphy and validated these results against the histological and/or microbiology results in every case.The positive and negative predictive values for the presence of infection were 83% and 93%, respectively. The diagnostic sensitivity was 88% and the specificity was 90%.This study indicates that triple-phase bone scintigraphy is a useful tool in the detection of peri-prosthetic infection and offers a cost-effective method of screening.

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Section: Methodsmentioning

confidence: 99%

Diagnosis of peri-prosthetic infection at the hip using triple-phase bone scintigraphy

Nagoya

Kaya

Sasaki

et al. 2008

The Journal of Bone and Joint Surgery. British volume

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“…They resumed a high sensitivity but a lack of specificity because the infected prostheses were sonicated in leaking plastic bags. 21 Using sterile containers instead of plastic bags and adding a vortexing step before sonication they modified this method resulting in a higher sensitivity of SC than that of the periprosthetic TC (78.5% vs. 60.8%, p < 0.001). 22 Piper et al 23 also reported a significant difference between SC and periprosthetic TCs (66.7% vs. 54.5%, p ¼ 0.046) for the detection of definite prosthetic shoulder infection.…”

Section: Discussionmentioning

confidence: 99%

Sonication cultures of explanted components as an add‐on test to routinely conducted microbiological diagnostics improve pathogen detection

Holinka

Bauer

Hirschl

et al. 2010

Journal Orthopaedic Research

142

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The purpose of this study was to improve the pathogen detection in prosthetic joint infections, particularly to evaluate the feasibility of the sonication culture method in the clinical routine. Explanted components of all patients with presumptive prosthetic or implant infection were sonicated separately in sterile containers to dislodge the adherent bacteria from the surfaces and cultured. The results of sonication culture were compared to the conventional tissue culture. We investigated 60 consecutive patients with loosening of the prostheses or implants Forty patients had septic and 20 aseptic loosening (24 knee prostheses, 21 hip prostheses, 6 mega-prostheses, 2 shoulder prostheses, 6 osteosynthesis, 1 spinal instrumentation). The sensitivity of sonication fluid culture was 83.3%, of single positive tissue culture was 72.2% and 61.1% when two or more cultures yielded the same microorganism. In patients receiving antibiotic therapy the sensitivity was 65.9%, 57.5%, and 42.5%, respectively. Pathogens detected in a single tissue culture as well as in sonication culture yielded a significantly higher rate of prosthetic infection than conventional tissue culture alone ( p ¼ 0.008), even in patients receiving continuous antibiotic therapy before explantation ( p ¼ 0.016). The sonication method represents an essential add-on in pathogen detection compared to conventional tissue culture. ß

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“…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)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(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).…”

mentioning

confidence: 99%

“…Further, various factors, including antibiotic use and specimen contamination, may influence the diagnostic ability of SFC (12,14,16,17). We identified 120 false-negative results from 12 studies.…”

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confidence: 99%

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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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Sonication of Explanted Prosthetic Components in Bags for Diagnosis of Prosthetic Joint Infection Is Associated with Risk of Contamination

Cited by 188 publications

References 12 publications

Diagnosis of peri-prosthetic infection at the hip using triple-phase bone scintigraphy

Diagnosis of peri-prosthetic infection at the hip using triple-phase bone scintigraphy

Sonication cultures of explanted components as an add‐on test to routinely conducted microbiological diagnostics improve pathogen detection

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

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