Advertisement

Clinical Orthopaedics and Related Research®

, Volume 468, Issue 8, pp 2238–2243 | Cite as

Blood Culture Flasks for Culturing Synovial Fluid in Prosthetic Joint Infections

  • Lluís Font-Vizcarra
  • Sebastián García
  • Juan C. Martínez-Pastor
  • Josep M. Sierra
  • Alex Soriano
Clinical Research

Abstract

Background

Identifying the etiologic microorganism is essential to guide antimicrobial therapy in prosthetic joint infection.

Questions/purpose

We (1) compared the frequency of positive cultures with synovial fluid inoculated in blood culture flasks (SF) with those of periprosthetic tissues or swabs in traditional cultures from patients with acute and chronic prosthetic joint infections (PJI) and (2) determined the sensitivity, specificity, and predictive values of the three methods.

Patients and Methods

We retrospectively reviewed 87 patients with PJIs (54 knees, 33 hips) and 63 patients with aseptic loosening (34 knees, 29 hips). Two SF, periprosthetic tissue, and swab samples were taken for culture in all 150 patients except for 14 in whom only one SF fluid sample was obtained. Synovial fluid was inoculated in blood culture flasks and periprosthetic tissue and swab samples in standard media. Positive cultures were identified with standard biochemical procedures.

Results

SF samples were positive in 78 of 87 infected cases (90%), periprosthetic tissue samples were positive in 71 (82%), and swab samples were positive in 59 (68%). SF, periprosthetic tissue, and swab samples were positive more frequently in acute than in chronic infections (96% versus 82% for SF, 87% versus 74% for periprosthetic tissue, and 87% versus 44% for swabs). The sensitivity, specificity, and positive and negative predictive values of SF were 91, 100, 100, and 93 for acute infections and 79, 100, 100, and 88 for chronic infections, respectively.

Conclusions

SF samples cultured in flasks had higher sensitivity, specificity, and positive and negative predictive values for diagnosis of PJI when compared with standard tissue and swab samples. The usefulness of all samples was less in chronic than in acute infections.

Level of Evidence

Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Keywords

Synovial Fluid Aseptic Loosening Prosthetic Joint Infection Swab Sample Synovial Fluid Sample 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank all members of the Hip Unit (Dr. Riba, Dr. Gallart, Dr. Bori, Dr. Fernández-Valencia, and Dr. Combalia) and the Knee Unit (Dr. Maculé, Dr. Segur, Dr. Torner, Dr. Castillo, Dr. Popescu, Dr. Lozano, and Dr. Sastre) of our center for collaborating in taking samples during the surgeries. We also thank Dr. Mensa and Dr .Vila for help with revision of the manuscript.

References

  1. 1.
    Atkins BL, Athanasou N, Deeks JJ, Crook DW, Simpson H, Peto TE, McLardy-Smith P, Berendt AR. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group. J Clin Microbiol. 1998;36:2932–2939.PubMedGoogle Scholar
  2. 2.
    Austin MS, Ghanem E, Joshi A, Lindsay A, Parvizi J. A simple, cost-effective screening protocol to rule out periprosthetic infection. J Arthroplasty. 2008;23:65–68.CrossRefPubMedGoogle Scholar
  3. 3.
    Bori G, Soriano A, García S, Gallart X, Mallofre C, Mensa J. Neutrophils in frozen section and type of microorganism isolated at the time of resection arthroplasty for the treatment of infection. Arch Orthop Trauma Surg. 2009;129:591–595.CrossRefPubMedGoogle Scholar
  4. 4.
    Costerton JW. Biofilm theory can guide the treatment of device-related orthopaedic infections. Clin Orthop Relat Res. 2005;437:7–11.CrossRefPubMedGoogle Scholar
  5. 5.
    Della Valle CJ, Zuckerman JD, Di Cesare PE. Periprosthetic sepsis. Clin Orthop Relat Res. 2004;420:26–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Feldman DS, Lonner JH, Desai P, Zuckerman JD. The role of intraoperative frozen sections in revision total joint arthroplasty. J Bone Joint Surg Am. 1995;77:1807–1813.PubMedGoogle Scholar
  7. 7.
    Fitzgerald RH Jr, Peterson LF, Washington JA II, Van Scoy RE, Coventry MB. Bacterial colonization of wounds and sepsis in total hip arthroplasty. J Bone Joint Surg Am. 1973;55:1242–1250.PubMedGoogle Scholar
  8. 8.
    Hughes JG, Vetter EA, Patel R, Schleck CD, Harmsen S, Turgeant LT, Cockerill FR 3rd. Culture with BACTEC Peds Plus/F bottle compared with conventional methods for detection of bacteria in synovial fluid. J Clin Microbiol. 2001;39:4468–4471.CrossRefPubMedGoogle Scholar
  9. 9.
    Knobben BA, Engelsma Y, Neut D, van der Mei HC, Busscher HJ, van Horn JR. Intraoperative contamination influences wound discharge and periprosthetic infection. Clin Orthop Relat Res. 2006;452:236–241.CrossRefPubMedGoogle Scholar
  10. 10.
    Levine BR, Evans BG. Use of blood culture vial specimens in intraoperative detection of infection. Clin Orthop Relat Res. 2001;382:222–231.CrossRefPubMedGoogle Scholar
  11. 11.
    Moran E, Masters S, Berendt AR, McLardy-Smith P, Byren I, Atkins BL. Guiding empirical antibiotic therapy in orthopaedics: the microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention. J Infect. 2007;55:1–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Ritter MA, Stringer EA. Intraoperative wound cultures: their value and long-term effect on the patient. Clin Orthop Relat Res. 1981;155:180–185.PubMedGoogle Scholar
  13. 13.
    Schäfer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis. 2008;47:1403–1409.CrossRefPubMedGoogle Scholar
  14. 14.
    Toms AD, Davidson D, Masri BA, Duncan CP. The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg Br. 2006;88:149–155.PubMedGoogle Scholar
  15. 15.
    Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357:654–663.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Lluís Font-Vizcarra
    • 1
  • Sebastián García
    • 1
  • Juan C. Martínez-Pastor
    • 1
  • Josep M. Sierra
    • 2
  • Alex Soriano
    • 2
  1. 1.Department of Orthopaedics and Trauma Surgery of Hospital Clínic of BarcelonaBarcelonaSpain
  2. 2.Department of Infectious Diseases of Hospital Clínic of BarcelonaBarcelonaSpain

Personalised recommendations