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J Clin Microbiol. 2014 Dec;52(12):4176-82. doi: 10.1128/JCM.02140-14. Epub 2014 Sep 17.

Improved diagnosis of infection associated with osteosynthesis by use of sonication of fracture fixation implants.

Author information

1
Infection Control Unit, Santa Isabel Hospital, São Paulo, Brazil.
2
Division of Infectious Diseases, Department of Internal Medicine, Santa Casa de São Paulo School of Medicine, São Paulo, Brazil.
3
Department of Laboratory Medicine and Pathology, Santa Casa de São Paulo School of Medicine, São Paulo, Brazil.
4
Department of Orthopedic Surgery, Santa Casa de São Paulo School of Medicine, São Paulo, Brazil.
5
Division of Infectious Diseases, Department of Internal Medicine, Santa Casa de São Paulo School of Medicine, São Paulo, Brazil mcsalles@osite.com.br.

Abstract

Previous studies have shown that sonication fluid cultures from removed orthopedic devices improved the microbiological diagnosis of orthopedic implant-associated infections; however, few of these investigations have applied sonication to the removed fracture fixation devices to evaluate its utility for the diagnosis of osteosynthesis-associated infection (OAI). We compared sonication fluid to conventional tissue cultures from 180 subjects with different sizes of plates and screws (n = 156), spinal implants (n = 26), and intramedullary nails (n = 3), of whom 125 and 55 subjects had OAI and noninfected osteosynthesis (NIO), respectively. The sensitivity for detecting OAI was 90.4% for sonication fluid culture and 56.8% for periprosthetic tissue cultures (P < 0.05), and the specificities were 90.9% and 96.4%, respectively. Sonication fluid culture detected more pathogens than peri-implant tissue culture (113 versus 71; P < 0.001), while polymicrobial infections were diagnosed by sonication fluid cultures and tissue cultures in 20.8% and 8% (P < 0.001), respectively. Microbiological diagnosis was achieved exclusively by sonication fluid cultures for 47 (90.4%) subjects, and among them, 18 (38.3%) had previously received antibiotics, whereas in five (9.6%) infected subjects, tissue culture was positive and the sonication fluid culture was negative. Among 39 (31.2%) OAI cases receiving antibiotics, the identification of the organisms occurred in 38.5% and 82.1% of the tissue and sonication fluid cultures, respectively (P < 0.049). We demonstrated that sonication fluid culture from removed osteosyntheses has the potential for improving the microbiological diagnosis of OAI.

PMID:
25232155
PMCID:
PMC4313283
DOI:
10.1128/JCM.02140-14
[Indexed for MEDLINE]
Free PMC Article

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