Culturing periprosthetic tissue in blood culture bottles results in isolation of additional microorganisms

  • Wouter van den Bijllaardt
  • Olav P. van der Jagt
  • Marc Peijs
  • Marco Janssens
  • Anton G. Buiting
  • Anne Q. ReuwerEmail author
Original Article


Despite low sensitivity, culture of periprosthetic tissue (PPT) specimens on agars and in broths has traditionally been used for the detection of causative microorganisms in patients suspected for prosthetic joint infection (PJI). The aim of this study was to evaluate the added diagnostic value of culturing PPT in blood culture bottles (BCB) over the conventional combination of standard agar and broth alone. This prospective cohort study was conducted over a 12-month period and included consecutive patients undergoing revision arthroplasty. Overall, 113 episodes from 90 subjects were studied; 45 subjects (50.0%) met the Infectious Diseases Society of America (IDSA) criteria for PJI, of whom the majority (75.6%) had an acute infection. Sensitivity and specificity of culture were assessed using IDSA criteria for PJI as gold standard. Although the increase in sensitivity from 84.44 (CI 70.54; 93.51) to 93.33% (81.73; 98.60) was not significant, added diagnostic value of culturing PPT in BCBs was demonstrated by the significantly higher number of detected pathogens in culture sets with BCBs compared to culture without BCBs (61 pathogens in conventional set versus 89 when BCBs were included for 57 PJI episodes, P = <0.0001). In 17 (29.8%) episodes, microorganisms were cultured from BCBs only, and in 9 (52.9%) of these episodes, virulent pathogens were found. This study demonstrates that PPT culture in BCBs leads to isolation of additional microorganisms, both virulent and low-virulent, which were not cultured with use of agars and broths alone. Isolation of additional causative microorganisms has serious consequences for the treatment strategy in PJI.


Periprosthetic tissue Blood culture Prosthetic joint infection 



We thank all orthopaedic surgeons, clinical microbiologists, microbiological analysts and the application manager involved in this study for their participation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study has been performed in accordance with the institutional research committee (“Medisch Ethische Toetsingscommissie Brabant”; study protocol NW2017-28) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Study formal consent was not required since culturing blood culture bottles was already a method implemented by others as a standard procedure in their laboratories, and blood culture bottles were added to the conventional set of solid agars and broths.


  1. 1.
    Peel TN, Dylla BL, Hughes JG, Lynch DT, Greenwood-Quaintance KE, Cheng AC, Mandrekar JN, Patel R (2016) Improved diagnosis of prosthetic joint infection by culturing periprosthetic tissue specimens in blood culture bottles. MBio 7:e01776–e01715CrossRefGoogle Scholar
  2. 2.
    Minassian AM, Newnham R, Kalimeris E, Bejon P, Atkins BL, Bowler IC (2014) Use of an automated blood culture system (BD BACTEC) for diagnosis of prosthetic joint infections: easy and fast. BMC Infect Dis 14:233–240CrossRefGoogle Scholar
  3. 3.
    Trampuz A, Widmer AF (2006) Infections associated with orthopedic implants. Curr Opin Infect Dis 19:349–356CrossRefGoogle Scholar
  4. 4.
    Tande AJ, Patel R (2014) Prosthetic joint infection. Clin Microbiol Rev 27:302–345CrossRefGoogle Scholar
  5. 5.
    Drago L, De Vecchi E, Cappelletti L, Vassena C, Toscano M, Bortolin M, Mattina R, Romano CL (2015) Prolonging culture to 15 days improves bacterial detection in bone and joint infections. Eur J Clin Microbiol Infect Dis 34: 1809–1813Google Scholar
  6. 6.
    Butler-Wu SM, Burns EM, Pottinger PS, Magaret AS, Rakeman JL, Matsen FA 3rd, Cookson BT (2011) Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection. J Clin Microbiol 49:2490–2495CrossRefGoogle Scholar
  7. 7.
    Atkins BL, Athanasou N, Deeks JJ, Crook DW, Simpson H, Peto TE, McLardy-Smith P, Berendt AR (1998) Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group. J Clin Microbiol 36:2932–2939Google Scholar
  8. 8.
    Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR, Infectious Diseases Society of America (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56:e1–e25CrossRefGoogle Scholar
  9. 9.
    Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG (2011) New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 469:2992–2994CrossRefGoogle Scholar
  10. 10.
    Parvizi J, Gehrke T, Chen AF (2013) Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J 95-B:1450–1452CrossRefGoogle Scholar
  11. 11.
    Cazanave C, Greenwood-Quaintance KE, Hanssen AD, Patel R (2012) Corynebacterium prosthetic joint infection. J Clin Microbiol 50:1518–1523CrossRefGoogle Scholar
  12. 12.
    Schafer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L (2008) Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis 47:1403–1409CrossRefGoogle Scholar
  13. 13.
    Lutz MF, Berthelot P, Fresard A, Cazorla C, Carricajo A, Vautrin AC, Fessy MH, Lucht F (2005) Arthroplastic and osteosynthetic infections due to Propionibacterium acnes: a retrospective study of 52 cases, 1995–2002. Eur J Clin Microbiol Infect Dis 24:739–744CrossRefGoogle Scholar
  14. 14.
    Janz V, Wassilew GI, Hasart O, Matziolis G, Tohtz S, Perka C (2013) Evaluation of sonicate fluid cultures in comparison to histological analysis of the periprosthetic membrane for the detection of periprosthetic joint infection. Int Orthop 37:931–936CrossRefGoogle Scholar
  15. 15.
    Puig-Verdie L, Alentorn-Geli E, Gonzalez-Cuevas A, Sorli L, Salvado M, Alier A, Pelfort X, Portillo ME, Horcajada JP (2013) Implant sonication increases the diagnostic accuracy of infection in patients with delayed, but not early, orthopaedic implant failure. Bone Joint J 95-B:244–249CrossRefGoogle Scholar
  16. 16.
    Bujang MA, Adnan TH (2016) Requirements for minimum sample size for sensitivity and specificity snalysis. J Clin Diagn Res 10:YE01–YE06Google Scholar
  17. 17.
    Liu H, Zhang Y, Li L, Zou HC (2017) The application of sonication in diagnosis of periprosthetic joint infection. Eur J Clin Microbiol Infect Dis 36:1–9CrossRefGoogle Scholar
  18. 18.
    Cazanave C, Greenwood-Quaintance KE, Hanssen AD, Karau MJ, Schmidt SM, Gomez Urena EO, Mandrekar JN, Osmon DR, Lough LE, Pritt BS, Steckelberg JM, Patel R (2013) Rapid molecular microbiologic diagnosis of prosthetic joint infection. J Clin Microbiol 51:2280–2287CrossRefGoogle Scholar
  19. 19.
    Gomez E, Cazanave C, Cunningham SA, Greenwood-Quaintance KE, Steckelberg JM, Uhl JR, Hanssen AD, Karau MJ, Schmidt SM, Osmon DR, Berbari EF, Mandrekar J, Patel R (2012) Prosthetic joint infection diagnosis using broad-range PCR of biofilms dislodged from knee and hip arthroplasty surfaces using sonication. J Clin Microbiol 50:3501–3508CrossRefGoogle Scholar
  20. 20.
    Yan Q, Karau MJ, Greenwood-Quaintance KE, Mandrekar JN, Osmon DR, Abdel MP, Patel R (2018) Comparison of diagnostic accuracy of periprosthetic tissue culture in blood culture bottles to that of prosthesis sonication fluid culture for diagnosis of prosthetic joint infection (PJI) by use of Bayesian latent class modeling and IDSA PJI criteria for classification. J Clin Microbiol 56.

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Microvida Laboratory for MicrobiologyAmphia HospitalBredaThe Netherlands
  2. 2.Laboratory for Medical Microbiology and ImmunologyElisabeth-TweeSteden HospitalTilburgThe Netherlands
  3. 3.Department of OrthopaedicsElisabeth-TweeSteden HospitalTilburgThe Netherlands

Personalised recommendations