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Diagnosis of spacer-associated infection using quantitative cultures from sonicated antibiotics-loaded spacers: implications for the clinical outcome


Recent studies showed that a positive microbiological result from sonication of the PMMA spacer was associated with poor outcome of patients, but no quantitative analysis has yet been performed. For this purpose, a prospective analysis of 50 spacers (46 patients) was performed. All spacers were processed according to a previously described protocol, including centrifugation and quantitative culture. Clinical data and outcome were also analysed. A statistical relationship between the results of the cultures and the outcome of the patient was assessed. Sixteen patients were diagnosed with spacer-associated infection. Thirteen out of 50 spacers gave a positive culture. Nine of 13 presented with growth of an organism not isolated in the first-stage cultures, and in 7 out of 13 the organisms count was high (>10,000 CFU/ml). We have detected a significant statistical relationship between poor outcome and positive cultures, high colony counts, isolation of different organisms, positive periprosthetic cultures and spacer-associated infection. The detection in a sonicated, antibiotic-loaded PMMA spacer of organisms other than those isolated in the first surgical samples or high colony counts of any organisms is diagnostic with regard to spacer-associated infection.

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We acknowledge Dr Ignacio Mahillo-Fernandez, from the Statistics department of the IIS-Fundación Jiménez Díaz, for his help with the statistics.

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Correspondence to J. Esteban.

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This study was funded by the Spanish Ministry of Economy and Competitivity (MAT2013-48224-C2-2-R).

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The authors declare that they have no conflicts of interest.

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Esteban, J., Gadea, I., Pérez-Jorge, C. et al. Diagnosis of spacer-associated infection using quantitative cultures from sonicated antibiotics-loaded spacers: implications for the clinical outcome. Eur J Clin Microbiol Infect Dis 35, 207–213 (2016).

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  • Linezolid
  • Prosthetic Joint Infection
  • Infected Case
  • Cement Spacer
  • Resection Arthroplasty