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Background Culturing of samples of periprosthetic tissue is the standard method used for the microbiologic diagnosis of prosthetic-joint infection, but this method is neither sensitive nor specific. In prosthetic-joint infection, microorganisms are typically present in a biofilm on the surface of the prosthesis. We hypothesized that culturing of samples obtained from the prosthesis would improve the microbiologic diagnosis of prosthetic-joint infection.
Methods We performed a prospective trial comparing culture of samples obtained by sonication of explanted hip and knee prostheses to dislodge adherent bacteria from the prosthesis with conventional culture of periprosthetic tissue for the microbiologic diagnosis of prosthetic-joint infection among patients undergoing hip or knee revision or resection arthroplasty.
Results We studied 331 patients with total knee prostheses (207 patients) or hip prostheses (124 patients); 252 patients had aseptic failure, and 79 had prosthetic-joint infection. With the use of standardized nonmicrobiologic criteria to define prosthetic-joint infection, the sensitivities of periprosthetic-tissue and sonicate-fluid cultures were 60.8% and 78.5% (P<0.001), respectively, and the specificities were 99.2% and 98.8%, respectively. Fourteen cases of prosthetic-joint infection were detected by sonicate-fluid culture but not by prosthetic-tissue culture. In patients receiving antimicrobial therapy within 14 days before surgery, the sensitivities of periprosthetic tissue and sonicate-fluid culture were 45.0% and 75.0% (P<0.001), respectively.
Conclusions In this study, culture of samples obtained by sonication of prostheses was more sensitive than conventional periprosthetic-tissue culture for the microbiologic diagnosis of prosthetic hip and knee infection, especially in patients who had received antimicrobial therapy within 14 days before surgery.
Source Information
From the Division of Infectious Diseases, Department of Internal Medicine (A.T., K.E.P., M.J.J., A.D.H., D.R.O., J.M.S., R.P.), the Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology (F.R.C., R.P.), the Department of Orthopedic Surgery (A.D.H., K.K.U.), the Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology (K.K.U.), the Division of Biostatistics (J.N.M.), and the Ultrasound Research Laboratory (J.F.G.), Mayo Clinic College of Medicine, Rochester, MN.
Address reprint requests to Dr. Patel at the Division of Infectious Diseases, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN 55905, or at patel.robin{at}mayo.edu.
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