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J Infect. 2014 Jul;69(1):35-41. doi: 10.1016/j.jinf.2014.03.002. Epub 2014 Mar 12.

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

Author information

1
Microbiology Laboratory, Laboratori de Referència de Catalunya, MasBlau I, El Prat de Llobregat, 08820 Barcelona, Spain. Electronic address: eportillo@lrc.es.
2
Microbiology Laboratory, Laboratori de Referència de Catalunya, MasBlau I, El Prat de Llobregat, 08820 Barcelona, Spain.
3
Department of Orthopedic Surgery, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain.
4
Infectious Diseases Service, Department of Internal Medicine, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain.

Abstract

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.

KEYWORDS:

Periprosthetic tissue culture; Prosthetic joint infection; Sonication

PMID:
24631778
DOI:
10.1016/j.jinf.2014.03.002
[Indexed for MEDLINE]

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