Protez eklem enfeksiyonunun tanısında iki kültür ortamı tekniğinin etkinliğinin karşılaştırılması

Yıl 2025, Cilt: 15 Sayı: 1, 30 - 35, 31.01.2025

Mete Gedikbaş , Utkan Sobay , Mehmet Burtaç Eren , Murat Aşçı

https://doi.org/10.16899/jcm.1576595

Öz

Amaç: Bulaşıcı hastalıklardan şüphelenildiğinde, kültür çalışmaları uygun antimikrobiyal tedavinin seçilmesini sağlar ve tanıyı doğrular. Ortam, örnek toplama tekniği, zenginleştirme ve değerlendirme tekniklerinde çeşitli farklılıklar vardır.
Kültür örneklemesi, son yıllarda artroplasti oranının artmasıyla sıklığı artan protez eklem enfeksiyonlarının tanı ve tedavisine önemli katkılar sağlar.
Ameliyat öncesi ve sırasındaki kriterlerin birlikte değerlendirilmesiyle, şüpheli vakalarda kültür pozitifliği olmadan protez eklem enfeksiyonları teşhis edilebilir.
Bu çalışma, protez eklem enfeksiyonunun tanısı için farklı kültür örneklemelerinin etkinliğini değerlendirmeyi amaçlamaktadır.
Yöntemler: Bu çalışmada, Ocak 2005 ile Mayıs 2015 arasında bölümümüzde örneklenen 946 hasta retrospektif olarak değerlendirildi. Bu hastalar nihai tanılarına göre iki gruba ayrıldı: birinci grup (protez eklem enfeksiyonu) ve ikinci grup (şüpheli ancak enfekte olmayan protez eklem replasmanı). Hastaların son tanıları göz önünde bulundurularak, bu çalışmada kan kültürü şişesi (BCB) yöntemi ile standart steril sıvı kültür yönteminin sonuçları karşılaştırılmıştır.
Sonuçlar: Kan kültürü şişesinde kültür yapıldığında, kültür testinin duyarlılığı %28,09, özgüllüğü %95,77 ve doğruluğu %58,13 olarak bulunmuştur. Katı bir ortamda kültür yapıldığında, duyarlılığı %10,11, özgüllüğü %100 ve doğruluğu %50 olarak bulunmuştur.
Sonuçlar: Protez eklem enfeksiyonundan şüphelenildiğinde, BCB kullanımı daha yüksek tanı değerine sahip daha fazla bakteri izole etme gücüne sahip olduğundan standart steril sıvı kültür yöntemine kıyasla tercih edilen, daha güvenli bir yöntemdir.

Anahtar Kelimeler

protez eklem enfeksiyonu, kültür testi, bakteriyel tanımlama, tanısal doğruluk, kan kültürü şişeleri

Comparing the effectiveness of two culture media techniques in the diagnosis of prosthetic joint infection

Öz

Purpose: When infectious diseases are suspected, culture studies ensure the selection of the appropriate antimicrobial treatment and confirm the diagnosis. There are various differences in medium, sample collection technique, enrichment, and evaluation techniques.
Culture sampling makes important contributions to the diagnosis and treatment of prosthetic joint infections, the frequency of which has increased in recent years as a result of the increased rate of arthroplasty.
After evaluating the preoperative and intraoperative criteria together, prosthetic joint infections can be diagnosed in suspected cases without culture positivity.
This study aims to evaluate different culture samplings efficiency for the diagnosis of prosthetic joint infection.
Methods: This study retrospectively evaluated 946 patients who had been sampled in our department between January 2005 and May 2015. These patients were divided into two groups according to their final diagnoses: group one (prosthetic joint infection) and group two (suspected but non-infected prosthetic joint replacement). Considering patients' final diagnoses, this study aimed to compare the results of the blood culture bottle (BCB) method and the standard sterile fluid culture method.
Results: When cultivated in a blood culture flask, the sensitivity of the culture test was 28.09%, specificity was 95.77%, and accuracy was 58.13%. When cultivated in a solid medium, sensitivity was 10.11%, specificity was 100%, and accuracy was 50%.
Conclusions:When prosthetic joint infection is suspected, BCB usage is a preferable, safer method compared to the standard sterile fluid culture method because it has the power to isolate more bacteria with a higher diagnostic value.

Anahtar Kelimeler

blood culture bottles, culture assay, bacterial identification, diagnostic accuracy, prosthetic joint infection

Kaynakça

• 1. Hanssen A. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect. 1999 ;48:111-122
• 2. Saleh KJ, Rand JA, McQueen DA. Current status of revision total knee arthroplasty: how do we assess results? J Bone Joint Surg Am. 2003;85 (suppl_1):S18-S20.
• 3. Barrack RL. The value of preoperative knee aspiration: don't ask, don't tell. Orthopedics. 1997 20 (9):862-864 4. Duff GP, Lachiewicz PF, Kelley SS. Aspiration of the knee joint before revision arthroplasty. Clin Orthop Relat Res. 1996; 331:132-139.
• 5. Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ. Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg Am. 2007; 89 (4):871-882.
• 6. Hanssen AD, Osmon DR. Evaluation of a staging system for infected hip arthroplasty. Clin Orthop Relat Res. 2002 ;403:16-22.
• 7. Peel TN, Dylla BL, Hughes JG, Lynch DT, Greenwood-Quaintance KE, Cheng AC, et al. Improved diagnosis of prosthetic joint infection by culturing periprosthetic tissue specimens in blood culture bottles. Am Soc Microbiol. 2016; (1):e01776-01715.
• 8. Fuerst M, Fink B, Rüther W. The value of preoperative knee aspiration and arthroscopic biopsy in revision total knee arthroplasty. Z Orthop Ihre Grenzgeb. 2005; 143 (1):36-41
• 9. Williams JL, Norman P, Stockley I. The value of hip aspiration versus tissue biopsy in diagnosing infection before exchange hip arthroplasty surgery. J Arthroplasty. 2004; 19 (5):582-586.
• 10. Gollwitzer H, Diehl P, Gerdesmeyer L, Mittelmeier W. Diagnostic strategies in cases of suspected periprosthetic infection of the knee. A review of the literature and current recommendations. Der Orthopade. 2006 ;35(9):904, 906-8, 910-6.
• 11. Forbes B. Processing specimens for bacteria. Manual of Clinical Microbiology. 1995 6th ed:265-281
• 12. Isenberg, Henry D. Clinical microbiology procedures handbook. American Society of Microbiology, 1992. 13. Bourbeau P, Riley J, Heiter BJ, Master R, Young C, Pierson C. Use of the BacT/Alert blood culture system for culture of sterile body fluids other than blood. J Clin Microbiol. 1998; 36 (11):3273-3277.
• 14. Simor AE, Scythes K, Meaney H, Louie M. Evaluation of the BacT/Alert® microbial detection system with FAN aerobic and FAN anaerobic bottles for culturing normally sterile body fluids other than blood. Diagn Microbiol Infect Dis. 2000; 37 (1):5-9.
• 15. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011 ;469 (11):2992.
• 16. Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018; 33 (5):1309-1314. e1302.
• 17. von Essen R, Hölttä. Improved method of isolating bacteria from joint fluids by the use of blood culture bottles. Ann Rheum Dis. 1986; 45 (6):454-457.
• 18. Çetin ES, Kaya S, Demirci M, Aridogan BC. Comparison of the BACTEC blood culture system versus conventional methods for culture of normally sterile body fluids. Adv Ther. 2007 24 (6):1271-1277.
• 19. Birgisson H, Steingrimsson O, Gudnason T. Kingella kingae infections in paediatric patients: 5 cases of septic arthritis, osteomyelitis and bacteraemia. Scand J Infect Dis. 1997; 29 (5):495-498.
• 20. Yagupsky P, Dagan R, Howard CW, Einhorn M, Kassis I, Simu A. High prevalence of Kingella kingae in joint fluid from children with septic arthritis revealed by the BACTEC blood culture system. J Clin Microbiol. 1992; 30 (5):1278-1281.
• 21. Harris LG, El-Bouri K, Johnston S, Rees E, Frommelt L, Siemssen N, Christner M, Davies AP, Rohde H, Mack D. Rapid identification of staphylococci from prosthetic joint infections using MALDI-TOF mass-spectrometry. Int J Artif Organs. 2010; 33 (9):568-574.
• 22. Tande AJ, Patel R. Prosthetic joint infection. Clinical microbiology reviews. 2014; 27 (2):302-345
• 23. Menzies SM, Rahman NM, Wrightson JM, Davies HE, Shorten R, Gillespie SH, et al. Blood culture bottle culture of pleural fluid in pleural infection. Thorax. 2011; 66 (8):658-662.
• 24. Hughes JG, Vetter EA, Patel R, Schleck CD, Harmsen S, Turgeant LT, et al. Culture with BACTEC Peds Plus/F bottle compared with conventional methods for detection of bacteria in synovial fluid. J Clin Microbiol. 2001; 39 (12):4468-4471.
• 25. Portillo ME, Salvadó M, Trampuz A, Siverio A, Alier A, Sorli L, et al. Improved diagnosis of orthopedic implant-associated infection by inoculation of sonication fluid into blood culture bottles. J Clin Microbiol. 2015; 53 (5):1622-1627.