Assessment of sonication-based culture in diagnosing orthopedic implant infections: a comparative analysis with microbiological diagnostic approaches

Year 2023, , 1266 - 1271, 29.10.2023

Yavuz Çekli , Demet Ege

https://doi.org/10.32322/jhsm.1361635

Abstract

Aims: This study aimed to investigate the diagnostic advantages of microbiological culture, histopathological examination, and the management of sonication in the diagnosis of infections related to orthopedic implants and prostheses.
Methods: The study included 21 patients suspected of orthopedic implant or prosthesis-related infections. The classification of implant and prosthesis-related infections and the choice of treatment were based on the Infectious Diseases Society of America diagnostic and treatment guidelines. During the operations, samples were taken from the implant and inflamed tissue around the implant for each patient, and these samples were evaluated using standard culture, histopathological examination, and sonication methods.
Results: The sonication method exhibited a higher sensitivity in comparison to both tissue cultures and cultures acquired from implants and prostheses without the application of sonication (61.1% vs. 38.8% vs. 27.7%, P < 0.05, respectively). The count of isolated microorganisms was greater in the sonication method when compared to both tissue cultures and conventional cultures taken from implants and prostheses (16 vs. 10 vs. 6, P < 0.05, respectively). The sensitivity of the sonication method was found to be higher compared to conventional cultures, even among patients who had been administered preoperative antibiotics (p<0.05).
Conclusion: In the diagnosis of orthopedic implant and prosthesis infections, the sonication method was more effective as a diagnostic approach compared to conventional methods. A greater number of agents can be identified using the sonication method in infected tissues.

Keywords

Prosthesis, implant, infection, sonication

Ethical Statement

The study was performed in accordance with the Declaration of Helsinki, and was approved by the Gulhane Training and Research Hospital Clinical Research Ethics Committee (Approval Date: 22 June 2015, Decision No. 1491-88-14/1648.4-467).

Project Number

1491-88-14/1648.4-467

References

• Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1):e1-e25. doi:10.1093/cid/cis803
• Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780-785. doi:10.2106/JBJS.F.00222
• Conen A, Raabe A, Schaller K, Fux CA, Vajkoczy P, Trampuz A. Management of neurosurgical implant-associated infections. Swiss Med Wkly. 2020;150:w20208. doi:10.4414/smw.2020.20208
• Fischbacher A, Borens O. Prosthetic-joint Infections: Mortality Over The Last 10 Years. J Bone Jt Infect. 2019;4(4):198-202. doi:10.7150/jbji.35428
• Ronin D, Boyer J, Alban N, Natoli RM, Johnson A, Kjellerup BV. Current and novel diagnostics for orthopedic implant biofilm infections: a review. APMIS. 2022;130(2):59-81. doi:10.1111/apm.13197
• Wouthuyzen-Bakker M, Benito N, Soriano A. The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: a Systematic Review. J Clin Microbiol. Sep 2017;55(9):2765-2774. doi:10.1128/JCM.00640-17
• Scorzolini L, Lichtner M, Iannetta M, et al. Sonication technique improves microbiological diagnosis in patients treated with antibiotics before surgery for prosthetic joint infections. New Microbiol. 2014;37(3):321-328.
• Baratloo A, Hosseini M, Negida A, El Ashal G. Part 1: simple definition and calculation of accuracy, sensitivity and specificity. Emerg (Tehran) Spring. 2015;3(2):48-9.
• Song Z, Borgwardt L, Hoiby N, Wu H, Sorensen TS, Borgwardt A. Prosthesis infections after orthopedic joint replacement: the possible role of bacterial biofilms. Orthop Rev (Pavia). 2013;5(2):65-71. doi:10.4081/or.2013.e14
• Kaufman MG, Meaike JD, Izaddoost SA. Orthopedic prosthetic infections: diagnosis and orthopedic salvage. Semin Plast Surg. May 2016;30(2):66-72. doi:10.1055/s-0036-1580730
• Piper KE, Jacobson MJ, Cofield RH, et al. Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol. Jun 2009;47(6):1878-1884. doi:10.1128/JCM.01686-08
• Ponraj DS, Falstie-Jensen T, Bruggemann H, Lange J. The value of sonication on orthopaedic implants in an everyday clinical setting-an exploratory study. BMC Musculoskelet Disord. 2023;24(1):691. doi:10.1186/s12891-023-06796-x
• Dudareva M, Barrett L, Figtree M, et al. Sonication versus tissue sampling for diagnosis of prosthetic joint and other orthopedic device-related infections. J Clin Microbiol. 2018;56(12):e00688-18. doi:10.1128/JCM.00688-18
• Ricciardi BF, Muthukrishnan G, Masters EA, Kaplan N, Daiss JL, Schwarz EM. New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection. J Orthop Res. 2020;38(7):1423-1435. doi:10.1002/jor.24595
• Balato G, Franceschini V, Ascione T, Lamberti A, Balboni F, Baldini A. Diagnostic accuracy of synovial fluid, blood markers, and microbiological testing in chronic knee prosthetic infections. Arch Orthop Trauma Surg. 2018;138(2):165-171. doi:10.1007/s00402-017-2832-6
• Zajonz D, Wuthe L, Tiepolt S, et al. Diagnostic work-up strategy for periprosthetic joint infections after total hip and knee arthroplasty: a 12-year experience on 320 consecutive cases. Patient Saf Surg. 2015;9:20. doi:10.1186/s13037-015-0071-8
• Yano MH, Klautau GB, da Silva CB, et al. Improved diagnosis of infection associated with osteosynthesis by use of sonication of fracture fixation implants. J Clin Microbiol. 2014;52(12):4176-4182. doi:10.1128/JCM.02140-14
• Moran E, Byren I, Atkins BL. The diagnosis and management of prosthetic joint infections. J Antimicrob Chemother. 2010;65 Suppl 3:iii45-54. doi:10.1093/jac/dkq305
• Benito N, Mur I, Ribera A, et al. The Different Microbial Etiology of Prosthetic Joint Infections according to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms. J Clin Med. 2019;8(5):673. doi:10.3390/jcm8050673
• Achermann Y, Vogt M, Leunig M, Wust J, Trampuz A. Improved diagnosis of periprosthetic joint infection by multiplex PCR of sonication fluid from removed implants. J Clin Microbiol. Apr 2010;48(4):1208-1214. doi:10.1128/JCM.00006-10