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Swab Cultures Are Not As Effective As Tissue Cultures for Diagnosis of Periprosthetic Joint Infection

  • Symposium: 2012 Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

While it is accepted accurate identification of infecting organisms is crucial in guiding treatment of periprosthetic joint infection (PJI), there remains no consensus regarding the best method for obtaining cultures.

Questions/purposes

We compared the yield of intraoperative tissue samples versus swab cultures in diagnosing PJI.

Methods

Tissue and swab cultures (three each) were collected prospectively during a consecutive series of 156 aseptic and septic revision arthroplasties from October 2011 to April 2012. The tissues and swabs were taken from standardized regions of the joint. After excluding 39 reimplantation procedures, we included 117 cases (74 hip, 43 knee; 30 septic, 87 aseptic) for analysis. We used a modified version of the Musculoskeletal Infection Society criteria for defining PJI, requiring three of five rather than four of six criteria. Tissue and swab cultures from septic and aseptic cases were used to calculate their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying PJI.

Results

Tissue cultures were positive in a higher percentage of septic cases than swab cultures: 28 of 30 (93%) versus 21 of 30 (70%). Tissue cultures were positive in two of 87 aseptic cases (2%), while swab cultures were positive in 10 of 87 (12%). The sensitivity, specificity, PPV, and NPV were 93%, 98%, 93%, and 98%, respectively, for tissue cultures and 70%, 89%, 68%, and 90%, respectively, for swab cultures.

Conclusions

Tissue cultures demonstrated higher sensitivity, specificity, PPV, and NPV for diagnosing PJI than swab cultures. Swab cultures had more false-negative and false-positive results than tissue cultures. Because swab cultures pose a higher risk of not identifying or incorrectly identifying infecting organisms in PJI, we believe their use in obtaining intraoperative culture specimens should be discouraged.

Level of Evidence

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

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References

  1. Achermann Y, Vogt M, Leunig M, Wüst J, Trampuz A. Improved diagnosis of periprosthetic joint infection by multiplex PCR of sonication fluid from removed implants. J Clin Microbiol. 2010;48:1208–1214.

    Article  PubMed  Google Scholar 

  2. 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.

    PubMed  CAS  Google Scholar 

  3. Bedair H, Ting N, Jacovides C, Saxena A, Moric M, Parvizi J, Della Valle CJ. The Mark Coventry Award. Diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Relat Res. 2011;469:34–40.

    Article  PubMed  Google Scholar 

  4. Costerton JW. Biofilm theory can guide the treatment of device-related orthopaedic infections. Clin Orthop Relat Res. 2005;437:7–11.

    Article  PubMed  Google Scholar 

  5. Dy Chua J, Abdul-Karim A, Mawhorter S, Procop GW, Tchou P, Niebauer M, Saliba W, Schweikert R, Wilkoff BL. The role of swab and tissue culture in the diagnosis of implantable cardiac device infection. Pacing Clin Electrophysiol. 2005;28:1276–1281.

    Google Scholar 

  6. Font-Vizcarra L, García S, Martínez-Pastor JC, Sierra JM, Soriano A. Blood culture flasks for culturing synovial fluid in prosthetic joint infections. Clin Orthop Relat Res. 2010;468:2238–2243.

    Article  PubMed  Google Scholar 

  7. 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. Prosthetic joint infection diagnosis using broad-range PCR of biofilms dislodged from knee and hip arthroplasty surfaces using sonication. J Clin Microbiol. 2012;50:3501–3508.

    Article  PubMed  Google Scholar 

  8. Helstad AG, Kimball JL, Maki DG. Recovery of anaerobic, facultative, and aerobic bacteria from clinical specimens in three anaerobic transport systems. J Clin Microbiol. 1977;5:564–569.

    PubMed  CAS  Google Scholar 

  9. Koyonos L, Zmistowski B, Della Valle CJ, Parvizi J. Infection control rate of irrigation and débridement for periprosthetic joint infection. Clin Orthop Relat Res. 2011;469:3043–3048.

    Article  PubMed  Google Scholar 

  10. Malhotra R, Morgan DA. Role of core biopsy in diagnosing infection before revision hip arthroplasty. J Arthroplasty. 2004;19:78–87.

    Article  PubMed  Google Scholar 

  11. Nelson CL, McLaren AC, McLaren SG, Johnson JW, Smeltzer MS. Is aseptic loosening truly aseptic? Clin Orthop Relat Res. 2005;437:25–30.

    Article  PubMed  Google Scholar 

  12. Neut D, van Horn JR, van Kooten TG, van der Mei HC, Busscher HJ. Detection of biomaterial-associated infections in orthopaedic joint implants. Clin Orthop Relat Res. 2003;413:261–268.

    Article  PubMed  Google Scholar 

  13. Pandey R, Berendt AR, Athanasou NA. Histological and microbiological findings in non-infected and infected revision arthroplasty tissues. The OSIRIS Collaborative Study Group. Oxford Skeletal Infection Research and Intervention Service. Arch Orthop Trauma Surg. 2000;120:570–574.

    Article  PubMed  CAS  Google Scholar 

  14. Parvizi J, Della Valle CJ. AAOS Clinical Practice Guideline: diagnosis and treatment of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg. 2010;18:771–772.

    PubMed  Google Scholar 

  15. Parvizi J, Ghanem E, Menashe S, Barrack RL, Bauer TW. Periprosthetic infection: what are the diagnostic challenges? J Bone Joint Surg Am. 2006;88(suppl 4):138–147.

    Article  PubMed  Google Scholar 

  16. Parvizi J, Jacovides C, Zmistowski B, Jung KA. Definition of periprosthetic joint infection: is there a consensus? Clin Orthop Relat Res. 2011;469:3022–3030.

    Article  PubMed  Google Scholar 

  17. Parvizi J, Suh DH, Jafari SM, Mullan A, Purtill JJ. Aseptic loosening of total hip arthroplasty: infection always should be ruled out. Clin Orthop Relat Res. 2011;469:1401–1405.

    Article  PubMed  Google Scholar 

  18. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469:2992–2994.

    Article  PubMed  Google Scholar 

  19. Perry JL, Ballou DR, Salyer JL. Inhibitory properties of a swab transport device. J Clin Microbiol. 1997;35:3367–3368.

    PubMed  CAS  Google Scholar 

  20. Rasouli MR, Harandi AA, Adeli B, Purtill JJ, Parvizi J. Revision total knee arthroplasty: infection should be ruled out in all cases. J Arthroplasty. 2012;27:1239–1243.e1–2.

    Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. Schinsky MF, Della Valle CJ, Sporer SM, Paprosky WG. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am. 2008;90:1869–1875.

    Article  PubMed  Google Scholar 

  23. Spangehl MJ, Masri BA, O’Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am. 1999;81:672–683.

    PubMed  CAS  Google Scholar 

  24. Stoodley P, Ehrlich GD, Sedghizadeh PP, Hall-Stoodley L, Baratz ME, Altman DT, Sotereanos NG, Costerton JW, Demeo P. Orthopaedic biofilm infections. Curr Orthop Pract. 2011;22:558–563.

    Article  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  CAS  Google Scholar 

  26. Williams JL, Norman P, Stockley I. The value of hip aspiration versus tissue biopsy in diagnosing infection before exchange hip arthroplasty surgery. J Arthroplasty. 2004;19:582–586.

    Article  PubMed  Google Scholar 

  27. Wilson ML, Winn W. Laboratory diagnosis of bone, joint, soft-tissue, and skin infections. Clin Infect Dis. 2008;46:453–457.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank Donald Jungkind PhD and the Thomas Jefferson University Hospital surgical and microbiology laboratory staff for cooperation in undertaking and completing the protocol for this study. The authors also thank the Thomas Jefferson University Hospital nursing and surgical staff for cooperating and aiding in specimen collection for this study.

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Authors and Affiliations

  1. Rothman Institute of Orthopedics at Thomas Jefferson Hospital, 925 Chestnut Street, Philadelphia, PA, 19107, USA

    Vinay K. Aggarwal BS, Carlos Higuera MD, Gregory Deirmengian MD, Javad Parvizi MD, FRCS & Matthew S. Austin MD

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  1. Vinay K. Aggarwal BS
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  2. Carlos Higuera MD
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  3. Gregory Deirmengian MD
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  4. Javad Parvizi MD, FRCS
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  5. Matthew S. Austin MD
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Corresponding author

Correspondence to Javad Parvizi MD, FRCS.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Aggarwal, V.K., Higuera, C., Deirmengian, G. et al. Swab Cultures Are Not As Effective As Tissue Cultures for Diagnosis of Periprosthetic Joint Infection. Clin Orthop Relat Res 471, 3196–3203 (2013). https://doi.org/10.1007/s11999-013-2974-y

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  • DOI: https://doi.org/10.1007/s11999-013-2974-y

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