Advantages of sonication fluid culture for the diagnosis of prosthetic joint infection

• Published in: The Journal of infection Vol. 69; no. 1; pp. 35 - 41
• Main Authors: Portillo, María Eugenia, Salvadó, Margarita, Alier, Albert, Martínez, Santos, Sorli, Lluisa, Horcajada, Juan P, Puig, Lluis
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01-07-2014; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Arthritis - diagnosis; Biological and medical sciences; Cohort Studies; Diseases of the osteoarticular system; Female; General aspects; Humans; Infectious Disease; Male; Medical sciences; Microbiological Techniques - methods; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Periprosthetic tissue culture; Prospective Studies; Prostheses and Implants - microbiology; Prosthesis-Related Infections - diagnosis; Prosthetic joint infection; Sensitivity and Specificity; Sonication; Sonication - methods; Specimen Handling - methods; Time Factors; Periprosthetic tissue culture; Sonication; Prosthetic joint infection; Infection; Advantage; Prosthesis; Diseases of the osteoarticular system; Arthritis; Diagnosis
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2014.03.002

Summary Objectives The sensitivity of periprosthetic tissue culture is inadequate for the diagnosis of prosthetic joint infection (PJI). We investigated and compared the values of sonication fluid culture and periprosthetic tissue culture for diagnosing PJI. Methods Included were patients whose joint prosthesis had been removed for any reason. The resulting sonication fluid and periprosthetic tissues were cultured for 14 days. Results Of 231 explanted prostheses, aseptic failure was diagnosed in 162 cases (70%) and PJI in 69 (30%). In PJI cases, sonication fluid culture detected 62 microorganisms and periprosthetic tissue culture detected 45. Tissue and sonication fluid cultures showed sensitivities of 61% and 81%, respectively ( p  < 0.01), with specificity of 100% and 99%, respectively. On day 1, tissue and sonication fluid cultures were positive in 13% and 28% ( p  = 0.013) of PJI cases respectively, and on day 2, in 26% and 48% ( p  = 0.002) of cases. Four anaerobes grew in sonication fluid culture after 7–13 days incubation, whereas tissue culture missed 3 of these. Prolonged incubation of sonication fluid did not detect any organisms in the cases of aseptic failure. Conclusions Sonication fluid culture provides a more rapid diagnosis and detects about 30% more pathogens, although anaerobic organisms require up to 2 weeks of incubation.