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Performance Characteristics of Broth-only Cultures After Revision Total Joint Arthroplasty

  • Symposium: 2013 Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Surgeons frequently obtain intraoperative cultures at the time of revision total joint arthroplasty. The use of broth or liquid medium before applying the sample to the agar medium may be associated with contamination and false-positive cultures; however, the degree to which this is the case is not known.

Questions/purposes

We (1) calculated the performance characteristics of broth-only cultures (sensitivity, specificity, positive predictive value, and negative predictive value) and (2) characterized the organisms identified in broth to determine whether a specific organism showed increased proclivity for true-positive periprosthetic joint infection (PJI).

Methods

A single-institution retrospective chart review was performed on 257 revision total joint arthroplasties from 2009 through 2010. One hundred ninety (74%) had cultures for review. All culture results, as well as treatment, if any, were documented and patients were followed for a minimum of 1 year for evidence of PJI. Cultures were measured as either positive from the broth only or broth negative. The true diagnosis of infection was determined by the Musculoskeletal Infection Society criteria during the preoperative workup or postoperatively at 1 year for purposes of calculating the performance characteristics of the broth-only culture.

Results

The sensitivity, specificity, positive predictive value, and negative predictive value were 19%, 88%, 13%, and 92%, respectively. The most common organism identified was coagulase-negative Staphylococcus (16 of 24 cases, 67%). Coagulase-negative Staphylococcus was present in all three true-positive cases; however, it was also found in 13 of the false-positive cases.

Conclusions

The broth-only positive cultures showed poor sensitivity and positive predictive value but good specificity and negative predictive value. The good specificity indicates that it can help to rule in the presence of PJI; however, the poor sensitivity makes broth-only culture an unreliable screening test. We recommend that broth-only culture results be carefully scrutinized and decisions on the diagnosis and treatment of infection should be based specifically on the Musculoskeletal Infection Society criteria.

Level of Evidence

Level IV, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

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References

  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.

    PubMed  CAS  PubMed Central  Google Scholar 

  2. Bauer TW, Parvizi J, Kobayashi N, Krebs V. Diagnosis of periprosthetic infection. J Bone Joint Surg Am. 2006;88:869–882.

    Article  PubMed  Google Scholar 

  3. Bernard L, Lubbeke A, Stern R, Bru JP, Feron JM, Peyramond D, Denormandie P, Arvieux C, Chirouze C, Perronne C, Hoffmeyer P. Value of preoperative investigations in diagnosing prosthetic joint infection: retrospective cohort study and literature review. Scan J Infect Dis. 2004;36:410–416.

    Article  Google Scholar 

  4. Cartwright CP, Stock F, Gill VJ. Improved enrichment broth for cultivation of fastidious organisms. J Clin Microbiol. 1994;32:1825–1826.

    PubMed  CAS  PubMed Central  Google Scholar 

  5. Dalton H. Body fluid specimens, synovial fluid specimens. In: Dalton HP, Nottebart HC Jr, eds. Interpretative Medical Microbiology. New York, NY: Churchill Livingstone; 1986:875–900.

    Google Scholar 

  6. Della Valle C, Parvizi J, Bauer TW, Dicesare PE, Evans RP, Segreti J, Spangehl M, Watters WC 3rd, Keith M, Turkelson CM, Wies JL, Sluka P, Hitchcock K. Diagnosis of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg. 2010;18:760–770.

    Google Scholar 

  7. Derby P, Davies R, Oliver S. The value of including broth cultures as part of a routine culture protocol. J Clin Microbiol. 1997;35:1101–1102.

    PubMed  CAS  PubMed Central  Google Scholar 

  8. Dietz FR, Koontz FP, Found EM, Marsh JL. The importance of positive bacterial cultures of specimens obtained during clean orthopaedic operations. J Bone Joint Surg Am. 1991;73:1200–1207.

    PubMed  CAS  Google Scholar 

  9. Ghanem E, Ketonis C, Restrepo C, Joshi A, Barrack R, Parvizi J. Periprosthetic infection: where do we stand with regard to Gram stain? Acta Orthop. 2009;80:37–40.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Harbath, S, Samore MH, Lichtenberg D, Carmeli Y. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on the surgical site infections and antimicrobial resistance. Circulation. 2000;101:2916–2921.

    Article  Google Scholar 

  11. Isenberg HD, Baron EJ, D’Amato RF, Johnson RC, Murray PR, Rogers FG, von Graevenitz A. Recommendations for the isolation of bacteria from clinical specimens. In: Balows A, Hausler WJ Jr, Herrmann KL, Isenberg HD, Shadomy HJ, eds. Manual of Clinical Microbiology. 5th ed. Washington, DC: American Society for Microbiology; 1991:216–221.

    Google Scholar 

  12. Levine BR, Evans BG. Use of blood culture vial specimens in intraoperative detection of infection. Clin Orthop Relat Res. 2001;382:222–231.

    Article  PubMed  Google Scholar 

  13. Marin M, Esteban J, Meseguer MA, Sanchez-Somolinos M. Microbiological diagnosis of bone-joint infections. Enferm Infecc Microbiol Clin. 2010;28:534–540.

    Article  PubMed  Google Scholar 

  14. Marsik FJ. Central nervous system specimens. In: Dalton HP, Nottebart HC Jr, eds. Interpretive Medical Microbiology. New York, NY: Churchill Livingstone; 1986:196.

    Google Scholar 

  15. McMinn MT, Crawford JJ. Recovery of anaerobic microorganisms from clinical specimens in prereduced media versus recovery by routine clinical laboratory methods. Appl Microbiol. 1970;19:207–213.

    PubMed  CAS  PubMed Central  Google Scholar 

  16. Meehan J, Jamali AA, Nguyen H. Prophylactic antibiotics in hip and knee arthroplasty. J Bone Joint Surg Am. 2009;91:2480–2490.

    Article  PubMed  Google Scholar 

  17. Meredith FT, Phillips HK, Reller LB. Clinical utility of broth cultures of cerebrospinal fluid from patients at risk for shunt infections. J Clin Microbiol. 1997;35:3109–3111.

    PubMed  CAS  PubMed Central  Google Scholar 

  18. Morris AJ, Wilson SJ, Marx CE, Wilson ML, Mirrett S, Reller LB. Clinical impact of bacteria and fungi recovered only from broth cultures. J Clin Microbiol. 1995;33:161–165.

    PubMed  CAS  PubMed Central  Google Scholar 

  19. Oethinger M, Warner DK, Schindler SA, Kobayashi H, Bauer TW. Diagnosing periprosthetic infection: false positive intraoperative Gram stains. Clin Orthop Relat Res. 2011;469:954–960.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Reinhold CE, Nickolai DJ, Piccinini TE, Byford BA, York MK, Brooks GF. Evaluation of broth media for routine culture of cerebrospinal and joint fluid specimens. Am J Clin Pathol. 1988;89:671–674.

    PubMed  CAS  Google Scholar 

  21. Ritter MA, Stringer EA. Intraoperative wound cultures: their value and long-term effect on the patient. Clin Orthop Relat Res. 1981;155:180–185.

    PubMed  Google Scholar 

  22. Senneville E, Savage C, Nallet I, Yazdanpanah Y, Giraud F, Migaud H, Dubreuil L, Courcol R, Mouton Y. Improved aero-anaerobe recovery from infected prosthetic joint samples taken from 72 patients and collected intraoperatively in Rosenow’s broth. Acta Orthop. 2006;77:120–124.

    Article  PubMed  Google Scholar 

  23. Tsukayama PT, Estrada R, Gusheo RB. Infection after total hip arthroplasty. J Bone Joint Surg Am. 1996;78:512–523.

    PubMed  CAS  Google Scholar 

  24. Workgroup Convened by the Musculoskeletal Infection Society. New definition for periprosthetic joint infection. J Arthroplasty. 2011;26:1136–1138.

    Article  Google Scholar 

  25. Zwiel MG, Stroh DA, Johnson AJ, Marker DR, Mont MA. Gram stains have limited application in the diagnosis of infected total knee arthroplasty. Int J Infect Dis. 2011;15:e702–e705.

    Article  Google Scholar 

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Acknowledgments

The authors thank the Main Line Health Microbiology Department (Philadelphia, PA, USA) for analysis and reporting of the broth-only culture data.

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Authors and Affiliations

  1. The Rothman Institute at Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA, 19107, USA

    Eric B. Smith MD, Jenny Cai BS, Rachael Wynne RN, Mitchell Maltenfort PhD & Robert P. Good MD

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  1. Eric B. Smith MD
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  2. Jenny Cai BS
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  3. Rachael Wynne RN
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  4. Mitchell Maltenfort PhD
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Correspondence to Eric B. Smith MD.

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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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Smith, E.B., Cai, J., Wynne, R. et al. Performance Characteristics of Broth-only Cultures After Revision Total Joint Arthroplasty. Clin Orthop Relat Res 472, 3285–3290 (2014). https://doi.org/10.1007/s11999-014-3507-z

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