Sonication of Extracted Implants Improves Microbial Detection in Patients With Orthopedic Implant-Associated Infections

Ueda, Narumi; Oe, Kenichi; Nakamura, Tomohisa; Tsuta, Koji; Iida, Hiroya; Saito, Takanori

doi:10.1016/j.arth.2019.02.020

Cited by 13 publications

(22 citation statements)

References 33 publications

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“…However, the specificity was similar (90.2% vs. 92.9%, respectively; p = .65). Our results were in concordance with those of recent studies, that have mostly observed a superior sensitivity of SFC compared with PTC [10, 19, 20]. Two recent studies showed that the sensitivity of SFC was lower than that of PTC [21, 22].…”

Section: Discussionsupporting

confidence: 93%

Sonication of retrieved implants improves sensitivity in the diagnosis of periprosthetic joint infection

Bellova

Knop-Hammad

Königshausen

et al. 2019

BMC Musculoskelet Disord

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BackgroundSonication is a valuable tool in the diagnosis of periprosthetic joint infections (PJI). However, conditions and definition criteria for PJI vary among studies. The aim of this study was to determine the diagnostic performance (i.e., specificity, sensitivity) of sonicate fluid culture (SFC) against periprosthetic tissue culture (PTC), when using European Bone and Joint Infection Society (EBJIS) criteria.MethodsFrom March 2017 to April 2018, 257 implants were submitted for sonication. PJI was defined according to the EBJIS criteria as well as according to the International Consensus Meeting criteria of 2018 (ICM 2018). Only cases with at least one corresponding tissue sample were included. Samples were cultured using traditional microbiological plating techniques. Sensitivity and specificity were determined using two-by-two contingency tables. McNemar’s test was used to compare proportions among paired samples. Subgroup analysis was performed dividing the cohort according to the site of PJI, previous antibiotic treatment, and time of manifestation. Prevalence of pathogens was determined for all patients as well as for specific subgroups.ResultsAmong the 257 cases, 145 and 112 were defined as PJI and aseptic failure, respectively. When using the EBJIS criteria, the sensitivity of SFC and PTC was 69.0 and 62.8%, respectively (p = .04). Meanwhile, the specificity was 90.2 and 92.9%, respectively (p = .65). When adopting ICM 2018 criteria, the sensitivity of SFC and PTC was 87.5 and 84.4% (p = .63) respectively, while the specificity was 85.1 and 92.5% (p = .05), respectively. The most commonly identified pathogens were coagulase-negative staphylococci (26% overall), while 31% of PJI were culture-negative and 9% polymicrobial.ConclusionsSFC exhibited significantly greater sensitivity versus PTC when using the EBJIS criteria. Nevertheless, the diagnosis of PJI remains a difficult challenge and different diagnostic tools are necessary to optimize the outcome.

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Section: Discussionsupporting

confidence: 93%

Sonication of retrieved implants improves sensitivity in the diagnosis of periprosthetic joint infection

Bellova

Knop-Hammad

Königshausen

et al. 2019

BMC Musculoskelet Disord

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“…In addition, Prieto et al [35] further revealed that SFC (91.3%) was more sensitive for all infection types of implants than PTC (60.0%), synovial fluid (63.2%) and a combination of PTC and/or synovial fluid (66.7%); when conventional cultures were combined with SFC, the sensitivity improved significantly in total (from 60.2 to 77.1%) and delayed PJI (from 45.1 to 71.7%). It is interesting to note that SFC significantly improves pathogen detection, especially for patients who were administered antimicrobial therapy [13,26,32], and the sensitivity of SFCs was significantly superior to that of PTCs in patients who received antibacterial treatment within 14 days before operation (75.0% vs. 45.0%, p < 0.001), as reported by Trampuz et al [13].…”

Section: Discussionsupporting

confidence: 53%

Diagnostic accuracy of sonication fluid cultures from prosthetic components in periprosthetic joint infection: an updated diagnostic meta-analysis

et al. 2023

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Background Periprosthetic joint infection (PJI) is the most serious complication following total joint arthroplasty (TJA) and has a significant impact on patients and the national healthcare system. To date, the diagnosis of PJI is still confronted with dilemmas. The present study investigated the validity of sonication fluid culture (SFC) for removing implants in the diagnosis of PJI after joint replacement. Methods From database establishment to December 2020, relevant literature was retrieved from the PubMed, Web of Science, Embase and Cochrane Library databases. Two reviewers independently performed quality assessment and data extraction to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), area under the curve (AUC) and diagnostic odds ratio (DOR) to evaluate the diagnostic value of overall SFC for PJI. Results A total of 38 eligible studies including 6302 patients were selected in this study. The pooled sensitivity, specificity, PLR, NLR, and DOR of SFC for PJI diagnosis were 0.77 (95% confidence interval [CI], 0.76–0.79), 0.96 (95% CI, 0.95–0.96), 18.68 (95% CI, 11.92–29.28), 0.24 (95% CI, 0.21–0.29), and 85.65 (95% CI, 56.46–129.94), respectively, while the AUC was 0.92. Conclusion This meta-analysis showed that SFC was of great value in PJI diagnosis, and the evidence of SFC on PJI was more favorable but not yet strong. Therefore, improvement of the diagnostic accuracy of SFC is still necessary, and the diagnosis of PJI continues to warrant a multiplex approach before and during a revision procedure.

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“…Treatment decisions in disturbed fracture healing situations rely on a reliable diagnosis of presence or absence of infection. Established diagnostic criteria for FRI that have been adapted from PJI have so far failed to consider the unique circumstances of fracture healing complications [ 15 , 21 ]. The central issue in our investigation was to evaluate the diagnostic value of sonication in nonunion differentiation.…”

Section: Discussionmentioning

confidence: 99%

“…Trampuz et al calculated a CFU cut-off and defined 5 CFU/plate (corresponds to 10 CFU/ml) as the ideal threshold to discriminate between PJI and aseptic failure [ 19 ]. However, the CFU cut-offs used in studies range between 1 and 50 CFU/plate [ 8 , 10 , 21 , 25 – 30 ]. Different sonication protocols with variations in the initial fluid volume affect the CFU/ml concentration and prevent the definition of a universal cut-off value.…”

Section: Discussionmentioning

confidence: 99%

The value of sonication in the differential diagnosis of septic and aseptic femoral and tibial shaft nonunion in comparison to conventional tissue culture and histopathology: a prospective multicenter clinical study

Trenkwalder,

Erichsen,

Weisemann

et al. 2023

J Orthop Traumatol

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Background Septic and aseptic nonunion require different therapeutic strategies. However, differential diagnosis is challenging, as low-grade infections and biofilm-bound bacteria often remain undetected. Therefore, the examination of biofilm on implants by sonication and the evaluation of its value for differentiating between femoral or tibial shaft septic and aseptic nonunion in comparison to tissue culture and histopathology was the focus of this study. Materials and methods Osteosynthesis material for sonication and tissue samples for long-term culture and histopathologic examination from 53 patients with aseptic nonunion, 42 with septic nonunion and 32 with regular healed fractures were obtained during surgery. Sonication fluid was concentrated by membrane filtration and colony-forming units (CFU) were quantified after aerobic and anaerobic incubation. CFU cut-off values for differentiating between septic and aseptic nonunion or regular healers were determined by receiver operating characteristic analysis. The performances of the different diagnostic methods were calculated using cross-tabulation. Results The cut-off value for differentiating between septic and aseptic nonunion was ≥ 13.6 CFU/10 ml sonication fluid. With a sensitivity of 52% and a specificity of 93%, the diagnostic performance of membrane filtration was lower than that of tissue culture (69%, 96%) but higher than that of histopathology (14%, 87%). Considering two criteria for infection diagnosis, the sensitivity was similar for one tissue culture with the same pathogen in broth-cultured sonication fluid and two positive tissue cultures (55%). The combination of tissue culture and membrane-filtrated sonication fluid had a sensitivity of 50%, which increased up to 62% when using a lower CFU cut-off determined from regular healers. Furthermore, membrane filtration demonstrated a significantly higher polymicrobial detection rate compared to tissue culture and sonication fluid broth culture. Conclusions Our findings support a multimodal approach for the differential diagnosis of nonunion, with sonication demonstrating substantial usefulness. Level of Evidence: Level 2 Trial registration DRKS00014657 (date of registration: 2018/04/26)

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Sonication of Extracted Implants Improves Microbial Detection in Patients With Orthopedic Implant-Associated Infections

Cited by 13 publications

References 33 publications

Sonication of retrieved implants improves sensitivity in the diagnosis of periprosthetic joint infection

Sonication of retrieved implants improves sensitivity in the diagnosis of periprosthetic joint infection

Diagnostic accuracy of sonication fluid cultures from prosthetic components in periprosthetic joint infection: an updated diagnostic meta-analysis

The value of sonication in the differential diagnosis of septic and aseptic femoral and tibial shaft nonunion in comparison to conventional tissue culture and histopathology: a prospective multicenter clinical study

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