The Performance of a Dithiothreitol-Based Diagnostic System in Diagnosing Periprosthetic Joint Infection Compared to Sonication Fluid Cultures and Tissue Biopsies

Abstract

Purpose The aim of this study was to evaluate the performance of a commercially available dithiothreitol (DTT) kit for routine use in diagnosing periprosthetic joint infections (PJIs) in comparison to conventional microbiological tissue specimens and sonication procedures in a maximal care hospital. Methods We applied the DTT system in 40 consecutive cases of revision arthroplasty (23 PJIs and 17 aseptic revisions), with an exchange or a removal of components. The hardware components were split between the DTT system and the conventional sonication procedure. At least three tissue biopsies and a joint fluid specimen were sent for microbiological and histopathological analysis. Data was analysed retrospectively to compare between the different methods. Results Cultures of the DTT fluid showed a sensitivity of 65% and specificity of 100%, as referenced to conventional microbiological cultures. Sonication had better sensitivity (75%) but lower specificity (85%). The categorical agreement of DTT cultures compared to sonication fluid cultures was 78% (31/40). Neither pathogen type, infection duration nor antibiotic pretreatment influenced the accuracy of the DTT, but a low pH in the DTT seemed to be associated with false-negative results. Conclusion DTT was inferior in sensitivity when diagnosing PJIs compared to sonication fluid cultures and tissue biopsies. A low pH in the DTT fluid correlated with false-negative results. Nevertheless, the closed system of the DTT kit avoids contamination and false-positive results, and DTT can be an alternative where sonication is not available.

Dithiotreitol and Next Generation Sequencing of Bacterial 16S rRNA Shows Similar Diagnostic Security as Periprosthetic Tissue Cultures to Diagnose PJI

“…microbiological diagnostic might even be superior in identifying bacteria in septic cases compared to the detection using the microDTTect solution bacteria culture. Thus, our data are similar to those of Randau et al 2021, who described that pathogen identification based on DTT cultures was less sensitive than culturing from intra-operative tissue biopsies [33]. The comparison between microDTTect based bacteria cultures and standard diagnostic from tissue biopsy showed a sensitivity of 75% and a specificity of 92% for the microDTTect system, when taking MSIS criteria based PJI identification as reference.…”

“…Because of the easy and cost-effective use of DTT in comparison to sonication it was suggested as a possible alternative method. A further study showed that DTT and sonication are approximately equally sensitive [14], however, a third study indicated that DTT is inferior to sonication and conventional tissue culturing methods [33]. Therefore, literature does not provide a clear indication of whether the use of DTT can improve the diagnostic security of PJI or not.…”

Challenges in the Microbiological Diagnosis of Implant-Associated Infections: A Summary of the Current Knowledge

“…In contrast, no increase in sensitivity was observed among the 3 techniques for cases in which infection was suspected (Sambri et al, 2018). In contrast to Sambri et al (2018) and Randau et al (2020) recently reported that DTT fluid cultures were less sensitive than SFC (65% vs. 75%).…”

Sonication protocols and their contributions to the microbiological diagnosis of implant-associated infections: a review of the current scenario

“…The device was subsequently mechanically stirred for 15 minutes at room temperature, after which standard cultivation continued. For the sonication protocol, the explanted implants were collected in sterile plastic bags that were subsequently filled with sterile saline solution, vortexed for 30 seconds and sonicated in a Bactosonic 14.2 device (Bactosonic, Bandelin, Berlin, Germany) for 5 minutes with a frequency of 40 ± 2 kHz and a power density of 0.22 ± 0.04 W/cm2 followed by 30 seconds of vortexing ( Randau et al., 2021 ).…”

“…The analysis was performed using GraphPad Prism 8.0.2 (GraphPad Software, La Jolla, CA, USA). The categorical concordance of DTT cultures with that of SFC cultures was 78% (31/40) ( Randau et al., 2021 ).…”