Culturing periprosthetic tissue in blood culture bottles results in isolation of additional microorganisms
- 125 Downloads
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.
KeywordsPeriprosthetic 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.
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.
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.
- 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
- 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.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.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
- 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.Bujang MA, Adnan TH (2016) Requirements for minimum sample size for sensitivity and specificity snalysis. J Clin Diagn Res 10:YE01–YE06Google Scholar
- 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.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. https://doi.org/10.1128/JCM.00319-18