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Bakalakos M, Vlachos C, Ampadiotaki MM, Stylianakis A, Sipsas N, Pneumaticos S, Vlamis J. Role of Dithiothreitol in Detection of Orthopaedic Implant-Associated Infections. J Pers Med 2024; 14:334. [PMID: 38672961 PMCID: PMC11050915 DOI: 10.3390/jpm14040334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Orthopaedic implant-associated infections (OIAIs) represent a notable complication of contemporary surgical procedures, exerting a considerable impact on patient outcomes and escalating healthcare expenditures. Prompt diagnosis holds paramount importance in managing OIAIs, with sonication widely acknowledged as the preferred method for detecting biofilm-associated infections. Recently, dithiothreitol (DTT) has emerged as a potential substitute for sonication, owing to its demonstrated ability to impede biofilm formation. This study aimed to compare the efficacy of DTT with sonication in identifying microorganisms within implants. Conducted as a prospective cohort investigation, the study encompassed two distinct groups: patients with suspected infections undergoing implant removal (Group A) and those slated for hardware explantation (Group B). Hardware segments were assessed for biofilm-related microorganisms using both sonication and DTT, with a comparative analysis of the two methods. A total of 115 patients were enrolled. In Group A, no statistically significant disparity was observed between DTT and sonication. DTT exhibited a sensitivity of 89.47% and specificity of 96.3%. Conversely, in Group B, both DTT and sonication fluid cultures yielded negative results in all patients. Consequently, this investigation suggests that DTT holds comparable efficacy to sonication in detecting OIAIs, offering a novel, cost-effective, and readily accessible diagnostic modality for identifying implant-associated infections.
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Affiliation(s)
- Matthaios Bakalakos
- 3rd Orthopaedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (C.V.); (S.P.); (J.V.)
| | - Christos Vlachos
- 3rd Orthopaedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (C.V.); (S.P.); (J.V.)
| | | | | | - Nikolaos Sipsas
- Department of Pathophysiology, Laiko General Hospital, National and Kapodistrian University of Athens, School of Medicine, 11527 Athens, Greece
| | - Spiros Pneumaticos
- 3rd Orthopaedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (C.V.); (S.P.); (J.V.)
| | - John Vlamis
- 3rd Orthopaedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (C.V.); (S.P.); (J.V.)
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Dmitrov IA, Zagorodniy NV, Obolenskiy VN, Leval' PS, Zakharyan NG, Apresyan VS, Panin MA, Samkovich DA, Aliev RN, Grigoryan AA. Diagnosis and treatment of periprosthetic infection after hip replacement (a review). BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/vmi-rvz.2022.6.clin.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction. The frequency of hip arthroplasty is steadily increasing throughout the world and, although this operation has become routine, the likelihood of postoperative complications reaches 4.3 % [1]. The most dangerous of them are infectious lesions in the area of the endoprosthesis and adjacent tissues. At the same time, in addition to the threat of generalization of the infectious process, there are functional disorders in the joint area and a general deterioration in the quality of life of the patient. Timely diagnosis and treatment of the infectious process and related disorders can minimize the adverse effects of infection.Target. The purpose of this review is to analyze modern methods for diagnosing and treating periprosthetic infection resulting from hip replacement.Materials and methods. The subject literature was searched using the PubMed and Google Sholar databases.Results. The main methods for diagnosing periprosthetic infection include histological and bacteriological examination of the biopsy specimen, determination of sensitivity to antibiotics, blood, and synovial fluid analysis for the content of leukocytes, IL-6, CRP, PCR diagnostics of infectious agents. Treatment consists of re-intervention and/or antibiotic therapy.Conclusion. The most optimal method for diagnosing periprosthetic infection is a bacteriological study of biopsy specimens taken intraoperatively. The preferred method of treatment is determined by the severity of the infection, the degree of involvement of tissues adjacent to the prosthesis, the comorbid background, the nature of the infectious agent, and includes repeated revision surgery.
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Affiliation(s)
| | - N. V. Zagorodniy
- RUDN University; Pirogov Russian National Research Medical University
| | - V. N. Obolenskiy
- Pirogov Russian National Research Medical University; City Clinical Hospital No. 13
| | - P. Sh. Leval'
- City Clinical Hospital No. 13; European Clinic of Traumatology and Orthopedics (ECSTO)
| | | | | | - M. A. Panin
- RUDN University; City Clinical Hospital No. 17
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Moris V, Lam M, Amoureux L, Magallon A, Guilloteau A, Maldiney T, Zwetyenga N, Falentin-Daudre C, Neuwirth C. What is the best technic to dislodge Staphylococcus epidermidis biofilm on medical implants? BMC Microbiol 2022; 22:192. [PMID: 35933363 PMCID: PMC9356421 DOI: 10.1186/s12866-022-02606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Bacterial biofilm can occur on all medical implanted devices and lead to infection and/or dysfunction of the device. In this study, artificial biofilm was formed on four different medical implants (silicone, piccline, peripheral venous catheter and endotracheal tube) of interest for our daily clinical and/or research practice. We investigated the best conventional technic to dislodge the biofilm on the implants and quantified the number of bacteria. Staphylococcus epidermidis previously isolated from a breast implant capsular contracture on a patient in the university hospital of Dijon was selected for its ability to produce biofilm on the implants. Different technics (sonication, Digest-EUR®, mechanized bead mill, combination of sonication plus Digest-EUR®) were tested and compared to detach the biofilm before quantifying viable bacteria by colony counting. Results For all treatments, the optical and scanning electron microscope images showed substantial less biofilm biomass remaining on the silicone implant compared to non-treated implant. This study demonstrated that the US procedure was statistically superior to the other physical treatment: beads, Digest-EUR® alone and Digest-EUR® + US (p < 0.001) for the flexible materials (picc-line, PIV, and silicone). The number of bacteria released by the US is significantly higher with a difference of 1 log on each material. The result for a rigid endotracheal tube were different with superiority for the chemical treatment dithiothreitol: Digest-EUR®. Surprisingly the combination of the US plus Digest-EUR® treatment was consistently inferior for the four materials. Conclusions Depending on the materials used, the biofilm dislodging technique must be adapted. The US procedure was the best technic to dislodge S. epidermidis biofilm on silicone, piccline, peripheral venous catheter but not endotracheal tube. This suggested that scientists should compare themselves different methods before designing a protocol of biofilm study on a given material. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-022-02606-x.
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Affiliation(s)
- Vivien Moris
- Department of Maxillo-Facial Surgery, Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, University Hospital of Dijon, boulevard de Maréchal-de-Lattre-de-Tassigny, 21000, Dijon, France. .,Lipids Nutrition Cancer Team NuTox, UMR866, Université de Bourgogne Franche-Comté, 17 rue Paul Gaffarel, Dijon, 21000, France.
| | - Mylan Lam
- LBPS/CSPBAT, UMR CNRS 7244, Galilee Institute, Paris 13 University Sorbonne Paris Cité, 99 avenue JB, 93430, Clément, Villetaneuse, France
| | - Lucie Amoureux
- Department of Bacteriology, University Hospital of Dijon, Dijon Cedex, France.,UMR/CNRS 6249 Chrono-Environnement, University of Bourgogne Franche-Comté, Besançon, France
| | - Arnaud Magallon
- Department of Bacteriology, University Hospital of Dijon, Dijon Cedex, France.,UMR/CNRS 6249 Chrono-Environnement, University of Bourgogne Franche-Comté, Besançon, France
| | - Adrien Guilloteau
- Hospital Epidemiology and Hygiene Department, University of Franche-Comté, 11 Rue Claude Goudimel, Besançon, 25000, France
| | - Thomas Maldiney
- Lipids Nutrition Cancer Team NuTox, UMR866, Université de Bourgogne Franche-Comté, 17 rue Paul Gaffarel, Dijon, 21000, France.,Department of Intensive Care Medicine, William Morey General Hospital, Chalon-sur-Saône, France
| | - Narcisse Zwetyenga
- Department of Maxillo-Facial Surgery, Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, University Hospital of Dijon, boulevard de Maréchal-de-Lattre-de-Tassigny, 21000, Dijon, France.,Lipids Nutrition Cancer Team NuTox, UMR866, Université de Bourgogne Franche-Comté, 17 rue Paul Gaffarel, Dijon, 21000, France
| | - Céline Falentin-Daudre
- LBPS/CSPBAT, UMR CNRS 7244, Galilee Institute, Paris 13 University Sorbonne Paris Cité, 99 avenue JB, 93430, Clément, Villetaneuse, France
| | - Catherine Neuwirth
- Department of Bacteriology, University Hospital of Dijon, Dijon Cedex, France.,UMR/CNRS 6249 Chrono-Environnement, University of Bourgogne Franche-Comté, Besançon, France
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4
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Goh GS, Parvizi J. Diagnosis and Treatment of Culture-Negative Periprosthetic Joint Infection. J Arthroplasty 2022; 37:1488-1493. [PMID: 35101593 DOI: 10.1016/j.arth.2022.01.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/18/2022] [Indexed: 02/02/2023] Open
Abstract
Identification of the causative organism(s) in periprosthetic joint infection (PJI) is a challenging task. The shortcomings of traditional cultures have been emphasized in recent literature, culminating in a clinical entity known as "culture-negative PJI." Amidst the growing burden of biofilm infections that are inherently difficult to culture, the field of clinical microbiology has seen a paradigm shift from culture-based to molecular-based methods. These novel techniques hold much promise in the demystification of culture-negative PJI and revolutionization of the microbiology laboratory. This article outlines the clinical implications of culture-negative PJI, common causes of this diagnostic conundrum, established strategies to improve culture yield, and newer molecular techniques to detect infectious organisms.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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5
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Oliva A, Miele MC, Al Ismail D, Di Timoteo F, De Angelis M, Rosa L, Cutone A, Venditti M, Mascellino MT, Valenti P, Mastroianni CM. Challenges in the Microbiological Diagnosis of Implant-Associated Infections: A Summary of the Current Knowledge. Front Microbiol 2021; 12:750460. [PMID: 34777301 PMCID: PMC8586543 DOI: 10.3389/fmicb.2021.750460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022] Open
Abstract
Implant-associated infections are characterized by microbial biofilm formation on implant surface, which renders the microbiological diagnosis challenging and requires, in the majority of cases, a complete device removal along with a prolonged antimicrobial therapy. Traditional cultures have shown unsatisfactory sensitivity and a significant advance in the field has been represented by both the application of the sonication technique for the detachment of live bacteria from biofilm and the implementation of metabolic and molecular assays. However, despite the recent progresses in the microbiological diagnosis have considerably reduced the rate of culture-negative infections, still their reported incidence is not negligible. Overall, several culture- and non-culture based methods have been developed for diagnosis optimization, which mostly relies on pre-operative and intra-operative (i.e., removed implants and surrounding tissues) samples. This review outlines the principal culture- and non-culture based methods for the diagnosis of the causative agents of implant-associated infections and gives an overview on their application in the clinical practice. Furthermore, advantages and disadvantages of each method are described.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Claudia Miele
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Dania Al Ismail
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Federica Di Timoteo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Massimiliano De Angelis
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Luigi Rosa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antimo Cutone
- Department of Biosciences and Territory, University of Molise, Pesche, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Teresa Mascellino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Piera Valenti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Schulz P, Dlaska CE, Perka C, Trampuz A, Renz N. Preoperative synovial fluid culture poorly predicts the pathogen causing periprosthetic joint infection. Infection 2020; 49:427-436. [PMID: 33141393 PMCID: PMC8159841 DOI: 10.1007/s15010-020-01540-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/12/2020] [Indexed: 11/09/2022]
Abstract
Purpose We investigated the value of preoperative pathogen detection and evaluated its concordance with intraoperative cultures in patients with culture-positive periprosthetic joint infection (PJI). Methods Culture-positive PJI episodes with available preoperative (synovial fluid) and intraoperative cultures (periprosthetic tissue, synovial or sonication fluid) were analyzed. The pathogen detection rate in preoperative and intraoperative cultures was compared using Fisher’s exact test and their concordance was calculated. Results Among 167 included PJI episodes, 150 were monomicrobial with coagulase-negative staphylococci (n = 55, 37%), S. aureus (n = 34, 23%), and streptococci (n = 21, 14%) being the most common pathogens. Seventeen episodes (10%) were polymicrobial infections. The pathogen(s) grew in preoperative culture in 110 and in intraoperative cultures in 153 episodes (66% vs. 92%, p < 0.001). The pathogen detection rate was lower in preoperative compared to intraoperative cultures for low-virulent pathogens (40% vs. 94%, p < 0.001), polymicrobial infections (59% vs. 100%, p = 0.007), and in delayed and late PJI (63% vs. 94%, and 66% vs. 91%, respectively, p < 0.001). Full concordance of preoperative and intraoperative cultures was found in 87 episodes (52%). The pathogen was detected solely preoperatively in 14 episodes (8%) and solely intraoperatively in 57 cases (34%); an additional pathogen was found in 3 episodes (2%) preoperatively and in 6 episodes (4%) intraoperatively. Conclusion The concordance of preoperative and intraoperative cultures was poor (52%). The sole or an additional pathogen was found exclusively in intraoperative cultures in 38% of PJI episodes, hence preoperative synovial fluid cultures are considered unreliable for pathogen detection in PJI.
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Affiliation(s)
- Philipp Schulz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, 10117, Berlin, Germany
| | - Constantin E Dlaska
- Orthopaedic Research Institute of Queensland, 7 Turner Street, Pimlico, Townsville, QLD, 4812, Australia
| | - Carsten Perka
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, 10117, Berlin, Germany
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, 10117, Berlin, Germany
| | - Nora Renz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, 10117, Berlin, Germany.
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7
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Alaee F, Angerame M, Bradbury T, Blackwell R, Booth RE, Brekke AC, Courtney PM, Frenkel T, Grieco Silva FR, Heller S, Hube R, Ismaily S, Jennings J, Lee M, Noble PC, Ponzio D, Saxena A, Simpson H, Smith BM, Smith EB, Stephens S, Vasarhelyi E, Wang Q, Yeo SJ. General Assembly, Prevention, Operating Room - Surgical Technique: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S139-S146. [PMID: 30348556 DOI: 10.1016/j.arth.2018.09.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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8
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Abdel MP, Akgün D, Akin G, Akinola B, Alencar P, Amanatullah DF, Babazadeh S, Borens O, Vicente Cabral RM, Cichos KH, Deirmengian C, de Steiger R, Ghanem E, Radtke Gonçalves JR, Goodman S, Hamlin B, Hwang K, Klatt BA, Lee GC, Manrique J, Moon AS, Ogedegbe F, Salib CG, Tian S, Winkler T. Hip and Knee Section, Diagnosis, Pathogen Isolation, Culture: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S361-S367. [PMID: 30343972 DOI: 10.1016/j.arth.2018.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Erivan R, Villatte G, Eymond G, Mulliez A, Descamps S, Boisgard S. Usefulness of sonication for diagnosing infection in explanted orthopaedic implants. Orthop Traumatol Surg Res 2018; 104:433-438. [PMID: 29355743 DOI: 10.1016/j.otsr.2017.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 09/28/2017] [Accepted: 11/15/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Orthopaedic implant infection is a rare but serious complication whose optimal treatment requires an accurate microbiological diagnosis. The objective of this study was to determine whether culturing sonicated explants improved sensitivity compared to culturing standard sonicated soft-tissue samples. HYPOTHESIS Cultures of explant sonication fluid are more sensitive than cultures of soft-tissue sonication fluid in patients with implant infection. METHODS This single-centre retrospective study included all sonication fluid samples from implants explanted in orthopaedic surgery theatres for any reason. The microbiological results of the implant sonication fluid cultures were compared to those of cultures of sonicated soft-tissue and bone samples taken during the same procedure. The primary evaluation criterion was the difference in microorganisms recovered from explant sonication fluids versus fluid/tissue cultures. RESULTS The study included 187 explants removed between September 2009 and June 2015. Of the definite infections, 83% were identified by explant sonication, 86% by fluid/tissue cultures, and 91% by both techniques combined. Explant sonication recovered causative organisms in 10 patients with definite infection but negative fluid/soft tissue cultures. Antibiotic therapy prior to explantation was associated with lower sensitivity of explant sonication (57% vs. 67% for fluid/soft tissue cultures). CONCLUSION Explant sonication improved the diagnosis of infection when combined with fluid/soft tissue cultures. LEVEL OF EVIDENCE IV, retrospective single-centre study.
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Affiliation(s)
- R Erivan
- CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - G Villatte
- CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - G Eymond
- CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - A Mulliez
- Délégation à la recherche clinique et aux innovations (DRCI), CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - S Descamps
- CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - S Boisgard
- CNRS, SIGMA Clermont, ICCF, université Clermont-Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
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10
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Greimel F, Scheuerer C, Gessner A, Simon M, Kalteis T, Grifka J, Benditz A, Springorum HR, Schaumburger J. Efficacy of antibiotic treatment of implant-associated Staphylococcus aureus infections with moxifloxacin, flucloxacillin, rifampin, and combination therapy: an animal study. Drug Des Devel Ther 2017; 11:1729-1736. [PMID: 28652709 PMCID: PMC5476658 DOI: 10.2147/dddt.s138888] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The efficacy of antibiotic monotherapy and combination therapy in the treatment of implant-associated infection by Staphylococcus aureus was evaluated in an animal study. The femoral medullary cavity of 66 male Wistar rats was contaminated with S. aureus (ATCC 29213) and a metal device was implanted, of which 61 could be evaluated. Six treatment groups were studied: flucloxacillin, flucloxacillin in combination with rifampin, moxifloxacin, moxifloxacin in combination with rifampin, rifampin, and a control group with aqua. The treatment was applied for 14 days. After euthanasia, the bacterial counts in the periprosthetic bone, the soft tissue, and the implant-associated biofilm were measured. Both antibiotic combination treatments (moxifloxacin plus rifampin and flucloxacillin plus rifampin) achieved a highly significant decrease in microbial counts in the bone and soft tissue and in the biofilm. Mono-antibiotic treatments with either moxifloxacin or flucloxacillin were unable to achieve a significant decrease in microbial counts in bone and soft tissue or the biofilm, whilst rifampin was able to reduce the counts significantly only in the biofilm. Antibiotic resistance was measured in 1/3 of the cases in the rifampin group, whereas no resistance was measured in all other groups. The results show that combinations of both moxifloxacin and flucloxacillin plus rifampin are adequate for the treatment of periprosthetic infections due to infections with S. aureus, whereas monotherapies are not effective or not applicable due to the rapid development of antibiotic resistance. Therefore, moxifloxacin is an effective alternative in combination with rifampin for the treatment of implant-associated infections.
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Affiliation(s)
- Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach
| | - Christine Scheuerer
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach
| | - Andre Gessner
- Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Bavaria, Germany
| | - Michaela Simon
- Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Regensburg, Bavaria, Germany
| | - Thomas Kalteis
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach
| | - Achim Benditz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach
| | - Hans-Robert Springorum
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach
| | - Jens Schaumburger
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach
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What’s New in the Diagnosis and Treatment of Orthopedic Prostheses-Related Infections. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2017. [DOI: 10.1007/s40506-017-0116-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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12
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Franco-Cendejas R, Colín-Castro CA, Hernández-Durán M, López-Jácome LE, Ortega-Peña S, Cerón-González G, Vanegas-Rodríguez S, Mondragón-Eguiluz JA, Acosta-Rodríguez E. Leuconostoc mesenteroides periprosthetic knee infection, an unusual fastidious Gram-positive bacteria: a case report. BMC Infect Dis 2017; 17:227. [PMID: 28335753 PMCID: PMC5364644 DOI: 10.1186/s12879-017-2315-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/08/2017] [Indexed: 11/29/2022] Open
Abstract
Background Periprosthetic joint infections are mainly caused by Gram-positive cocci. Leuconostoc mesenteroides is a rare microorganism mainly causing bloodstream infections. At times, it might be confused with another type of cocci and give rise to misdiagnosed infections. Molecular diagnosis and biofilm production comprise important techniques to guide antibiotic treatment. Case presentation A 68-year-old Hispanic female with a previous history of bilateral knee arthroplasty presented with acute right-knee inflammation and gait impairment. Blood tests showed inflammatory response and knee x-ray revealed no prosthesis loosening. Irrigation and debridement was performed. Gram-positive cocci were obtained from cultures, and then biochemical and molecular identification revealed L. mesenteroides. Susceptibility and biofilm production were performed. The patient was treated with IntraVenous (IV) Ceftriaxone for ten days and was then switched to Amoxicillin-Clavulanate for 3 months with clinical and laboratory success. Conclusions Microbiology diagnosis of fastidious microorganisms is mandatory to treat periprosthetic joint infections adequately. L. mesenteroides may infect non-immunocompromised persons; however, treatment guidelines are lacking.
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Affiliation(s)
- Rafael Franco-Cendejas
- Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico.
| | - Claudia A Colín-Castro
- Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico
| | - Melissa Hernández-Durán
- Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico
| | - Luis E López-Jácome
- Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico
| | - Silvestre Ortega-Peña
- Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico
| | - Guillermo Cerón-González
- Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico
| | - Samuel Vanegas-Rodríguez
- Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico
| | - Jaime A Mondragón-Eguiluz
- Infectious Diseases Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico
| | - Eduardo Acosta-Rodríguez
- Hip and Knee Reconstruction Department, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Av. México-Xochimilco #289 Col. Arenal de Guadalupe. Del. Tlalpan, Mexico City, CP, 14389, Mexico
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Flow Chamber System for the Statistical Evaluation of Bacterial Colonization on Materials. MATERIALS 2016; 9:ma9090770. [PMID: 28773891 PMCID: PMC5457037 DOI: 10.3390/ma9090770] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 11/16/2022]
Abstract
Biofilm formation on materials leads to high costs in industrial processes, as well as in medical applications. This fact has stimulated interest in the development of new materials with improved surfaces to reduce bacterial colonization. Standardized tests relying on statistical evidence are indispensable to evaluate the quality and safety of these new materials. We describe here a flow chamber system for biofilm cultivation under controlled conditions with a total capacity for testing up to 32 samples in parallel. In order to quantify the surface colonization, bacterial cells were DAPI (4`,6-diamidino-2-phenylindole)-stained and examined with epifluorescence microscopy. More than 100 images of each sample were automatically taken and the surface coverage was estimated using the free open source software g’mic, followed by a precise statistical evaluation. Overview images of all gathered pictures were generated to dissect the colonization characteristics of the selected model organism Escherichia coli W3310 on different materials (glass and implant steel). With our approach, differences in bacterial colonization on different materials can be quantified in a statistically validated manner. This reliable test procedure will support the design of improved materials for medical, industrial, and environmental (subaquatic or subaerial) applications.
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Wasko MK, Goodman SB. Emperor's new clothes: Is particle disease really infected particle disease? J Orthop Res 2016; 34:1497-504. [PMID: 27175824 PMCID: PMC5529039 DOI: 10.1002/jor.23292] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 05/10/2016] [Indexed: 02/04/2023]
Abstract
Aseptic loosening remains the most significant long-term complication of total hip replacement. The current paradigm points to an inflammatory response to wear particles as its main trigger. Recently, there have been increasing numbers of positive bacterial isolates reported among patients with clinically absent infection. This paper reviews existing evidence on possible involvement of bacteria and microbial-associated molecular patterns in the pathology of so-called "aseptic loosening." © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1497-1504, 2016.
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Affiliation(s)
- Marcin K. Wasko
- Department of Orthopaedic and Rheumoorthopaedic Surgery, The Medical Centre of Postgraduate Education, Warsaw, Poland,Foundation for the Development of Medicine, Slupsk, Poland,SPSK im. Prof. A. Grucy, Konarskiego 13, Otwock 05-400, Poland
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery, Orthopaedic Surgery Laboratories, Stanford University, Stanford, California,Department of Bioengineering, Stanford University, Stanford, California
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Nagoya S, Sasaki M, Kaya M, Okazaki S, Tateda K, Yamashita T. Extraction of well-fixed extended porous-coated cementless stems using a femoral longitudinal split procedure. EUROPEAN ORTHOPAEDICS AND TRAUMATOLOGY 2015; 6:417-421. [PMID: 26691340 PMCID: PMC4673093 DOI: 10.1007/s12570-015-0322-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 07/28/2015] [Indexed: 11/28/2022]
Abstract
We present a technique of posterior femoral longitudinal split (FLS) osteotomy. This technique allows the expansion of the metaphyseal–diaphyseal region of the proximal femur facilitating extraction of well-fixed extended porous-coated stems. The extractions were performed using extended transfemoral osteotomy (ETO) and FLS osteotomy between June 2002 and March 2014. The study group, which comprised patients with well-fixed extended porous-coated stems, consisted of two men and ten women with an average age of 63.2 years. The stem was successfully removed using the FLS procedure in 8 of the 10 hips. Reimplantation surgery was performed in 6 of the 12 hips with ARMD, periprosthetic infection, or metallosis. This FLS technique may allow the easy removal of well-fixed extended porous-coated stems and become an alternative method for the removal of all stems.
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Affiliation(s)
- Satoshi Nagoya
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Sapporo, Japan
| | - Mikito Sasaki
- Department of Orthopedic Surgery, Sapporo Medical University, South 1 West 16, Chuo-Ku Sapporo, 060-8543 Japan
| | - Mitsunori Kaya
- Department of Orthopedic Surgery, Sapporo Medical University, South 1 West 16, Chuo-Ku Sapporo, 060-8543 Japan
| | - Shunichiro Okazaki
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Sapporo, Japan
| | - Kenji Tateda
- Department of Orthopedic Surgery, Sapporo Medical University, South 1 West 16, Chuo-Ku Sapporo, 060-8543 Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University, South 1 West 16, Chuo-Ku Sapporo, 060-8543 Japan
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Kempthorne JT, Ailabouni R, Raniga S, Hammer D, Hooper G. Occult Infection in Aseptic Joint Loosening and the Diagnostic Role of Implant Sonication. BIOMED RESEARCH INTERNATIONAL 2015; 2015:946215. [PMID: 26583149 PMCID: PMC4637070 DOI: 10.1155/2015/946215] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/06/2015] [Accepted: 07/07/2015] [Indexed: 02/04/2023]
Abstract
Our aim was to determine the incidence of occult infection and to examine the role of ultrasound sonication of the implants in cases of presumed aseptic loosening in a prospective trial. Joint swabs, aspirates, and deep tissue samples were obtained from around the prosthesis for routine microbiology. Each prosthesis was sonicated and the sonicate examined with Gram staining and extended cultures. There were 106 joints in the study of which 54 were revised for aseptic loosening and 52 were assigned to the control revision group. There were 9 positive cultures with 8/54 positive cultures in the aseptic loosening group and 1/52 in the control revision group (p = 0.017, associated OR 47.7). We found concordant results between sonication fluid culture and conventional samples in 5/9 cultures. Preoperative inflammatory markers were not prognostic for infection. Coagulase-negative Staphylococcus was the most commonly cultured organism (7/9). Previously unrecognised infection was present in 15% of patients undergoing revision for aseptic loosening. Ultrasound sonication of the removed prosthesis was less sensitive than conventional sampling techniques. We recommend routine intraoperative sampling for patients having revision for aseptic loosening, but we do not support the routine use of ultrasound sonication for its detection.
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Affiliation(s)
- J. T. Kempthorne
- Department of Orthopaedic Surgery, Christchurch Hospital, Private Bag 4710, Christchurch 8140, New Zealand
| | - R. Ailabouni
- Department of Orthopaedic Surgery, Christchurch Hospital, Private Bag 4710, Christchurch 8140, New Zealand
| | - S. Raniga
- Department of Orthopaedic Surgery, Christchurch Hospital, Private Bag 4710, Christchurch 8140, New Zealand
| | - D. Hammer
- Department of Microbiology, Northland DHB, Private Bag 9742, Whangarei 0148, New Zealand
| | - G. Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch 8140, New Zealand
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Fernandez-Sampedro M, Salas-Venero C, Fariñas-Álvarez C, Sumillera M, Pérez-Carro L, Fakkas-Fernandez M, Gómez-Román J, Martínez-Martínez L, Fariñas MC. 26Postoperative diagnosis and outcome in patients with revision arthroplasty for aseptic loosening. BMC Infect Dis 2015; 15:232. [PMID: 26084830 PMCID: PMC4470055 DOI: 10.1186/s12879-015-0976-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 06/03/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The most common cause of implant failure is aseptic loosening (AL), followed by prosthetic joint infection (PJI). This study evaluates the incidence of PJI among patients operated with suspected AL and whether the diagnosis of PJI was predictive of subsequent implant failure including re-infection, at 2 years of follow up. METHODS Patients undergoing revision hip or knee arthroplasty due to presumed AL from February 2009 to September 2011 were prospectively evaluated. A sonication fluid of prosthesis and tissue samples for microbiology and histopathology at the time of the surgery were collected. Implant failure include recurrent or persistent infection, reoperation for any reason or need for chronic antibiotic suppression. RESULTS Of 198 patients with pre-and intraoperative diagnosis of AL, 24 (12.1 %) had postoperative diagnosis of PJI. After a follow up of 31 months (IQR: 21 to 38 months), 9 (37.5 %) of 24 patients in the PJI group had implant failure compared to only 1 (1.1 %) in the 198 of AL group (p < 0.0001). Sensitivity of sonicate fluid culture (>20 CFU) and peri-prosthetic tissue culture were 87.5 % vs 66.7 %, respectively. Specificities were 100 % for both techniques (95 % CI, 97.9-100 %). A greater number of patients with PJI (79.1 %) had previous partial arthroplasty revisions than those patients in the AL group (56.9 %) (p = 0.04). In addition, 5 (55.5 %) patients with PJI and implant failure had more revision arthroplasties during the first year after the last implant placement than those patients with PJI without implant failure (1 patient; 6.7 %) (RR 3.8; 95 % CI 1.4-10.1; p = 0.015). On the other hand, 6 (25 %) patients finally diagnosed of PJI were initially diagnosed of AL in the first year after primary arthroplasty, whereas it was only 16 (9.2 %) patients in the group of true AL (RR 2.7; 95 % CI 1.2-6.1; p = 0.03). CONCLUSIONS More than one tenth of patients with suspected AL are misdiagnosed PJI. Positive histology and positive peri-implant tissue and sonicate fluid cultures are highly predictive of implant failure in patients with PJI. Patients with greater number of partial hip revisions for a presumed AL had more risk of PJI. Early loosening is more often caused by hidden PJI than late loosening.
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Affiliation(s)
- Marta Fernandez-Sampedro
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Avenida de Valdecilla s/n, Santander, 39008, Spain.
| | - Carlos Salas-Venero
- Department of Microbiology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.
| | - Concepción Fariñas-Álvarez
- Health Care Quality Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.
| | - Manuel Sumillera
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.
| | - Luis Pérez-Carro
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.
| | - Michel Fakkas-Fernandez
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.
| | - Javier Gómez-Román
- Department of Pathology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.
| | - Luis Martínez-Martínez
- Department of Microbiology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.
| | - María Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Avenida de Valdecilla s/n, Santander, 39008, Spain.
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Oliva A, Pavone P, D'Abramo A, Iannetta M, Mastroianni CM, Vullo V. Role of Sonication in the Microbiological Diagnosis of Implant-Associated Infections: Beyond the Orthopedic Prosthesis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 897:85-102. [PMID: 26566645 DOI: 10.1007/5584_2015_5007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Implant-associated infections are difficult-to-treat conditions associated with high morbidity, mortality and length of hospitalization. They are characterized by biofilm formation on implant surface, which makes the microbiological diagnosis difficult and requires a complete device removal for the correct management. The sonication method, which is based on the application of long-wave ultrasounds radiating in a liquid medium, has been recently validated for the diagnosis of prosthetic joint infections. Additionally, this technique has been considered a potential tool in order to improve the microbiological diagnosis of infections associated with other foreign bodies, such as breast, urinary, endovascular and cerebral implants. In the present study, the application of sonication in the setting of implant-associated infections other than orthopedics will be reviewed.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
| | - Paola Pavone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandra D'Abramo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Marco Iannetta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Bergmann PA, Tamouridis G, Lohmeyer JA, Mauss KL, Becker B, Knobloch J, Mailänder P, Siemers F. The effect of a bacterial contamination on the formation of capsular contracture with polyurethane breast implants in comparison with textured silicone implants: an animal study. J Plast Reconstr Aesthet Surg 2014; 67:1364-70. [PMID: 24953446 DOI: 10.1016/j.bjps.2014.05.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 03/23/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION One of the most common complications following breast augmentation is capsular contracture. The subclinical infection of the implant is often considered to be one of the main risk factors. It is believed that polyurethane (PU) implants, because of their larger foam-like surface, have lower capsular contracture rates due to better tissue integration. It remains unclear if bacterial contamination and biofilm formation result in higher capsular contracture rates under the condition of the increased surface of PU implants compared to textured silicone-gel implants. The effect of this bacterial contamination was examined in an animal-based study. METHODS A total of 80 mini implants (40 textured silicone-gel implants and 40 PU implants) were implanted in the dorsum of female Wistar rats. In each group, 20 implants were inoculated before implantation with a standard amount of Staphylococcus epidermidis. Capsules and implants were explanted after 60 days, followed by double-blind histological, immunohistochemical, and microbiological examinations. RESULTS Macroscopic separation of the total capsule in the textured implant group was possible whereas the growth of surrounding tissue into the foam structure of PU implants made separation in that group difficult. After contamination, a thicker capsule could be observed in both groups without significant differences. Histologically, capsules around PU implants showed significantly lower expression of parallel myofibrils. We were able to describe a significant higher infiltration with inflammatory cells in capsules around PU implants both with and without contamination. Microbiological investigations revealed positive growth of S. epidermidis around one PU implant without related signs of capsular contracture. DISCUSSION This study demonstrates that aside from the surface of silicone implants, bacterial contamination has major impact on the architecture of capsule formation. In our study, we were able to demonstrate that bacterial contamination leads to a thicker capsule and an increased tissue reaction with a higher amount of inflammatory cells. However, a resulting bacterial infection was only demonstrated in one case and had an insignificant influence on capsule architecture. The observed inflammatory reaction around PU implants was observed as a nonbacterial, granulomatose foreign body reaction. EBM RATING Level I: Evidence obtained from at least one properly designed randomized controlled trial.
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Affiliation(s)
- Philipp A Bergmann
- Department for Plastic and Handsurgery, Burn Unit, Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle (Saale), Germany.
| | - Georgious Tamouridis
- Department for Plastic and Handsurgery, Burn Unit, Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle (Saale), Germany
| | - Jörn A Lohmeyer
- Department for Plastic Surgery, AGAPLESION Diakonieklinikum Hamburg, Hamburg, Germany
| | - Karl L Mauss
- Plastic Surgery, Handsurgery, Burn Unit, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Benedikt Becker
- Plastic Surgery, Handsurgery, Burn Unit, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Johannes Knobloch
- Institute for Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Peter Mailänder
- Plastic Surgery, Handsurgery, Burn Unit, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Frank Siemers
- Department for Plastic and Handsurgery, Burn Unit, Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle (Saale), Germany
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Urish KL, DeMuth PW, Craft DW, Haider H, Davis CM. Pulse lavage is inadequate at removal of biofilm from the surface of total knee arthroplasty materials. J Arthroplasty 2014; 29:1128-32. [PMID: 24439797 DOI: 10.1016/j.arth.2013.12.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/27/2013] [Accepted: 12/08/2013] [Indexed: 02/01/2023] Open
Abstract
In acute periprosthetic infection, irrigation and debridement with component retention has a high failure rate in some studies. We hypothesize that pulse lavage irrigation is ineffective at removing biofilm from total knee arthroplasty (TKA) components. Staphylococcus aureus biofilm mass and location was directly visualized on arthroplasty materials with a photon collection camera and laser scanning confocal microscopy. There was a substantial reduction in biofilm signal intensity, but the reduction was less than a ten-fold decrease. This suggests that irrigation needs to be further improved for the removal of biofilm mass below the necessary bioburden level to prevent recurrence of acute infection in total knee arthroplasty.
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Affiliation(s)
- Kenneth L Urish
- Department of Orthopaedics and Rehabilitation, Division of Musculoskeletal Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Peter W DeMuth
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - David W Craft
- Department of Pathology, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Hani Haider
- Orthopaedics Biomechanics & Advanced Surgical Technologies Laboratory, Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebrasca
| | - Charles M Davis
- Department of Orthopaedics and Rehabilitation, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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Ribera A, Morata L, Moranas J, Agulló JL, Martínez JC, López Y, García D, Cabo J, García-Ramiro S, Soriano A, Murillo O. Clinical and microbiological findings in prosthetic joint replacement due to aseptic loosening. J Infect 2014; 69:235-43. [PMID: 24861245 DOI: 10.1016/j.jinf.2014.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 04/26/2014] [Accepted: 05/08/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES A role for microorganisms in aseptic prosthetic loosening (AL) is postulated. We analyse the microbiological and clinical findings of patients with suspected AL, and compare them with patients with chronic prosthetic joint infection (PJI). METHODS Prospective study (2011-2012) of patients with presumed AL. Evaluation of tissue samples (≥5; TS) at the time of surgery and sonication fluid (SF) of prosthesis. RESULTS According to positive culture in TS/SF, 89 patients were divided into: Group1: (≥2 positive-TS; n = 12); Group2: single positive-TS and concordant SF (n = 10); Group3: one positive or non-concordant TS or SF (n = 38); and Group4: cultures negative (n = 29). Positive-SF was always concordant with TS in Group 1 (75%); it was positive in 74% in Group 3. Median months (prosthesis-age: implantation to revision arthroplasty) for PJI and Group 1-4 was 21, 46, 65, 63 and 81, respectively (P < 0.001); they also had a different dynamic trend in prosthesis failure (P < 0.001). CONCLUSIONS Several patients with suspected AL are misdiagnosed PJI. Results from SF correlated well with TS in Group 1, led us to consider single positive-TS as significant (Group 2) and to suggest that microorganisms were on the prosthesis (Group 3). We observed a correlation between microbiology and prosthesis-age, which supports that early loosening is more often caused by hidden PJI than late loosening.
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Affiliation(s)
- A Ribera
- Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain.
| | - L Morata
- Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Clínic, Barcelona, Spain
| | - J Moranas
- Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - J L Agulló
- Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - J C Martínez
- Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Clínic, Barcelona, Spain
| | - Y López
- Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Clínic, Barcelona, Spain
| | - D García
- Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - J Cabo
- Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - S García-Ramiro
- Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Clínic, Barcelona, Spain
| | - A Soriano
- Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Clínic, Barcelona, Spain
| | - O Murillo
- Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
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Abstract
Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided.
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Affiliation(s)
- Aaron J. Tande
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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23
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Drago L, Signori V, De Vecchi E, Vassena C, Palazzi E, Cappelletti L, Romanò D, Romanò CL. Use of dithiothreitol to improve the diagnosis of prosthetic joint infections. J Orthop Res 2013; 31:1694-9. [PMID: 23817975 DOI: 10.1002/jor.22423] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 06/06/2013] [Indexed: 02/04/2023]
Abstract
Diagnosis of prosthetic joint infections (PJIs) remains a challenge for microbiologists, despite new techniques for bacteria isolation have been developed in recent years. A widely recognized standard method has not yet been indicated mainly because of limitations due difficult procedures and need of dedicated instrumentation. We evaluated the ability of a sulfhydryl compound routinely used in microbiology laboratories, dithiothreitol (DTT), to dislodge bacteria from biofilm, keeping them alive and cultivable for identification and antibiotic susceptibility testing. We compared DTT treatment against sonication of prosthesis and culture of periprosthetic tissues, in order to establish if it could be introduced in routine microbiological diagnosis of PJIs. The study was conducted on 76 patients, 34 with aseptic loosening of their prosthesis and 42 who were diagnosed for PJI. DTT treatment gave results similar to sonication in terms of bacterial yielding. Sonication provided higher sensitivity (71.4%) and specificity (94.1%) respect to periprosthetic tissue culture, while DTT showed the same specificity of sonication but a better sensitivity (85.7%), especially when the causative microorganism was Staphylococcus epidermidis. In conclusion, we demonstrated that DTT could be used for PJIs diagnosis, thanks to its ease of use and its high sensitivity and specificity.
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Affiliation(s)
- Lorenzo Drago
- Laboratory of Clinical Chemistry and Microbiology, I.R.C.C.S. Galeazzi Orthopaedic Institute, Milan, Italy; Laboratory of Medical Technical Sciences, Department of Biochemical Sciences for Health, University of Milan, Milan, Italy
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Song Z, Borgwardt L, Høiby N, Wu H, Sørensen TS, Borgwardt A. Prosthesis infections after orthopedic joint replacement: the possible role of bacterial biofilms. Orthop Rev (Pavia) 2013; 5:65-71. [PMID: 23888204 PMCID: PMC3718238 DOI: 10.4081/or.2013.e14] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 03/10/2013] [Accepted: 03/10/2013] [Indexed: 12/16/2022] Open
Abstract
Prosthesis-related infection is a serious complication for patients after orthopedic joint replacement, which is currently difficult to treat with antibiotic therapy. Consequently, in most cases, removal of the infected prosthesis is the only solution to cure the infection. It is, therefore, important to understand the comprehensive interaction between the microbiological situation and the host immune responses that lead to prosthesis infections. Evidence indicates that prosthesis infections are actually biofilm-correlated infections that are highly resistant to antibiotic treatment and the host immune responses. The authors reviewed the related literature in the context of their clinical experience, and discussed the possible etiology and mechanism leading to the infections, especially problems related to bacterial biofilm, and prophylaxis and treatment of infection, including both microbiological and surgical measures. Recent progress in research into bacterial biofilm and possible future treatment options of prosthesis-related infections are discussed.
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25
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Sonication of explanted cardiac implants improves microbial detection in cardiac device infections. J Clin Microbiol 2012. [PMID: 23196364 DOI: 10.1128/jcm.02230-12] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The sonication technique has been shown to be a promising tool for microbiological diagnosis of device-related infections. We evaluated the usefulness of the sonication method for pathogen detection in 80 explanted cardiac components collected from 40 patients, and the results were compared with those of conventional cultures. Forty subjects undergoing cardiac device removal were studied: 20 had cardiac device infection, and 20 subjects underwent elective generator replacement or revision in the absence of infection. Sonication of explanted devices was more sensitive than traditional culture for microbial detection (67% and 50%, respectively; P = 0.0005). The bacterial count detected in sonication fluid culture was significantly higher than that detected in traditional culture in both infected (P = 0.019) and uninfected (P = 0.029) devices. In the infected patients, sonication fluid culture yielded a significantly higher rate of pathogen detection in explanted electrodes than traditional culture (65% versus 45%; P = 0.02), while no differences were found in the generators. Ten strains were detected only through sonication fluid culture: 6 Staphylococcus epidermidis strains, 1 Staphylococcus hominis strain, 2 Corynebacterium striatum strains, and 1 Brevundimonas sp. Neither the type nor the duration of antimicrobial therapy before device removal had an effect on the diagnostic performance of sonication fluid culture (P = 0.75 and P = 0.56, respectively). In the patients without infection, sonication fluid culture was positive in 8 cases (40%), whereas conventional culture was positive in only 4 (20%). In summary, the sonication technique improves the microbiological diagnosis of explanted cardiac devices.
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Differential Bacterial Load on Components of Total Knee Prosthesis in Patients with Prosthetic Joint Infection. Int J Artif Organs 2012; 35:735-41. [DOI: 10.5301/ijao.5000152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2012] [Indexed: 11/20/2022]
Abstract
Purpose The purpose of our study was to evaluate and quantify the bacterial adherence on different components of total knee prosthesis with the sonication culture method. Methods Explanted components of all patients with presumptive prosthetic or implant infection were treated by sonication separately in sterile containers to dislodge the adherent bacteria from the surfaces and cultured. The bacterial load of the different knee components (femur, tibia, PE-inlay and patella) was evaluated by counting of colony-forming units (CFU) dislodged from the components surfaces using the sonication culture method. Results Overall, 27 patients had positive sonication cultures of explanted total knee prostheses. Microorganisms were detected from 88 of 100 explanted components. Twenty femoral components were culture positive and 7 negative, 23 tibial components as well as 23 polyethylene (PE) platforms had positive microorganism detection from the surface. Staphylococcus epidermidis adhered to the highest number of components whereas Staphylococcus aureus yielded the highest load of CFU in the sonication cultures. Although not significant, PE-inlays and tibial components were most often affected. The highest CFU count was detected in polyethylene components. Conclusion The sonication culture method is a reliable method to detect bacteria from the components. Additionally, the results demonstrate that bacterial adherence is not affecting a single component of knee prosthesis only. Thus, in septic revision surgery partial prosthetic exchange or exchange of single polyethylene components alone may be not sufficient.
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Bonilla AG, Smith KJ. Minimally invasive repair of a calcaneus fracture in a Standardbred foal. J Am Vet Med Assoc 2012; 241:1209-13. [PMID: 23078569 DOI: 10.2460/javma.241.9.1209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 4-month-old Standardbred colt was examined because of a fractured right calcaneus of 8 days' duration with increased distraction of the fracture fragment evident on sequential radiographs. CLINICAL FINDINGS The foal was severely lame with diffuse periarticular tarsal swelling. Radiographically, a complete, displaced long oblique fracture of the right calcaneal body was evident. Because the fracture gap was increasing with time and lameness remained severe, despite medical management, surgical repair was recommended. TREATMENT AND OUTCOME The foal was anesthetized, and minimally invasive fracture reduction and internal fixation were achieved by use of two 4.5-mm cortical screws placed in lag fashion via stab incisions over the lateral aspect of the calcaneus. External coaptation with a Robert-Jones bandage only was used after surgery. The foal recovered well and the fracture healed appropriately, but at 8 weeks following surgery, tenosynovitis of the tarsal sheath had developed. This was attributed to the tip of the distal screw encroaching on the sheath. The screw was removed under anesthesia and the tarsal sheath drained. The tenosynovitis resolved with rest and bandaging. Fourteen months after surgery, the colt was free of lameness. CLINICAL RELEVANCE Findings suggested that a minimally invasive internal fixation technique for treatment of a calcaneus fracture in horses may be successful and may be associated with decreased morbidity, compared with the use of open reduction and plate fixation.
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Affiliation(s)
- Alvaro G Bonilla
- Milton Equine Hospital, 10207 Guelph Line, Campbellville, ON L0P 1B0, Canada
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Nandakumar V, Chittaranjan S, Kurian VM, Doble M. Characteristics of bacterial biofilm associated with implant material in clinical practice. Polym J 2012. [DOI: 10.1038/pj.2012.130] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Sorlí L, Puig L, Torres-Claramunt R, González A, Alier A, Knobel H, Salvadó M, Horcajada JP. The relationship between microbiology results in the second of a two-stage exchange procedure using cement spacers and the outcome after revision total joint replacement for infection: the use of sonication to aid bacteriological analysis. ACTA ACUST UNITED AC 2012; 94:249-53. [PMID: 22323695 DOI: 10.1302/0301-620x.94b2.27779] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patients with infected arthroplasties are normally treated with a two-stage exchange procedure using polymethylmethacrylate bone cement spacers impregnated with antibiotics. However, spacers may act as a foreign body to which micro-organisms may adhere and grow. In this study it was hypothesised that subclinical infection may be diagnosed with sonication of the surface biofilm of the spacer. The aims were to assess the presence of subclinical infection through sonication of the spacer at the time of a second-stage procedure, and to determine the relationship between subclinical infection and the clinical outcome. Of 55 patients studied, 11 (20%) were diagnosed with subclinical infection. At a mean follow-up of 12 months (interquartile range 6 to 18), clinical failure was found in 18 (32.7%) patients. Of the patients previously diagnosed with subclinical infection, 63% (7 of 11) had failed compared with 25% (11 of 44) of those without subclinical infection (odds ratio 5.25, 95% confidence interval 1.29 to 21.4, p = 0.021). Sonication of the biofilm of the surface of the spacer is useful in order to exclude subclinical infection and therefore contributes to improving the outcome after two-stage procedures.
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Affiliation(s)
- L Sorlí
- Parc de Salut Mar, Service of Internal Medicine and Infectious Diseases, Passeig Marítim 25-29, Passeig Marítim 25-29, E-08003 Barcelona, Spain.
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Casey A, Karpanen T, Nightingale P, Cook M, Elliott T. Microbiological comparison of a silver-coated and a non-coated needleless intravascular connector in clinical use. J Hosp Infect 2012; 80:299-303. [DOI: 10.1016/j.jhin.2012.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/17/2012] [Indexed: 10/28/2022]
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Sierra JM, García S, Martínez-Pastor JC, Tomás X, Gallart X, Vila J, Bori G, Maculé F, Mensa J, Riba J, Soriano A. Relationship between the degree of osteolysis and cultures obtained by sonication of the prostheses in patients with aseptic loosening of a hip or knee arthroplasty. Arch Orthop Trauma Surg 2011; 131:1357-61. [PMID: 21559986 DOI: 10.1007/s00402-011-1307-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The pathogenesis of prosthesis loosening is not well understood. The aim of our study was to sonicate components of joint prostheses removed due to aseptic loosening, culture the sonicate fluid, and to correlate these results with the degree of radiological osteolysis. METHODS From January 2008 to June 2009 all consecutive patients who underwent a revision of hip or knee prosthesis due to aseptic loosening were included in the study. Aseptic loosening was established when the patient had radiological signs of loosening without symptoms or signs of infection. The diagnosis was confirmed when histology was negative, and ≥ 5 out of 6 standard cultures of periprosthetic tissue were negative. Bone lysis was measured according to the Paprosky or Engh classifications without knowing the result of sonication cultures. Removed components were placed in sterile bags and immediately transported to the microbiology laboratory and sonicated. Sonicate fluid was cultured and the results were correlated with the degree of bone lysis. The proportion of components with positive sonication culture according to the bone lysis classification was compared using χ(2) test. RESULTS A total of 52 patients were included and 123 components were sonicated. In 30 patients at least 1 sonicated component was positive (57.7%) and 44 out of 123 (35.8%) components were positive. The proportion of positive sonication cultures was significantly higher in the group of components with a higher degree of bone lysis of 3 (76.5%) than in those with lower degrees (33.9% for 1 and 24% for 2) (χ(2) test, p = 0.0004). CONCLUSIONS Sonication cultures were positive in 57% of patients who underwent revision arthroplasty for aseptic loosening. The percentage of positive sonication cultures was significantly higher in patients with severe osteolysis. LEVEL OF EVIDENCE level I of Prognostic Studies-Investigating the Effect of a Patient Characteristic on the Outcome of Disease.
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Affiliation(s)
- Josep M Sierra
- Department of Microbiology, Hospital Clínic of Barcelona, Barcelona, Spain
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Aseptic loosening of total hip arthroplasty: infection always should be ruled out. Clin Orthop Relat Res 2011; 469:1401-5. [PMID: 21365337 PMCID: PMC3069261 DOI: 10.1007/s11999-011-1822-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 02/10/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is believed that some cases of aseptic failure of THA may be attributable to occult infections. However, it is unclear whether preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are more likely elevated in these patients than those without overt infection. QUESTIONS/PURPOSES We asked whether some patients with aseptic THA failures have abnormal serologic indicators of periprosthetic joint infection (PJI) at the time of revision, namely ESR and/or CRP. METHODS Three hundred twenty-three revision THAs for aseptic loosening from 2004 to 2007 were retrospectively evaluated. We categorized all cases into two groups: (1) those with overt PJI (n = 14) plus patients who had a positive intraoperative culture during the index revision (n = 13) and (2) those who did not require rerevision (n = 276) or required surgery for noninfected causes (n = 20). Mean and frequency of abnormal ESR and CRP were compared between the two groups. The minimum followup was 11 months (average, 35 months; range, 11-54 months). RESULTS The mean and frequency of abnormal CRP in first group (n = 27) at 2.1 mg/dL and 48% respectively, were greater than those of the uninfected (n = 296) at 1.2 mg/dL and 27%, respectively. However, there were no differences between two groups regarding mean or frequency of abnormal ESR. CONCLUSION Some patients with presumed aseptic loosening may have abnormal serologic indicators of PJI that either have escaped diagnosis or were not adequately investigated. All patients undergoing revision THA should have ESR and CRP measured preoperatively and those with abnormal CRP should have additional evaluations to rule out or confirm PJI.
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Holinka J, Bauer L, Hirschl AM, Graninger W, Windhager R, Presterl E. Sonication cultures of explanted components as an add-on test to routinely conducted microbiological diagnostics improve pathogen detection. J Orthop Res 2011; 29:617-22. [PMID: 21337398 DOI: 10.1002/jor.21286] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 09/21/2010] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to improve the pathogen detection in prosthetic joint infections, particularly to evaluate the feasibility of the sonication culture method in the clinical routine. Explanted components of all patients with presumptive prosthetic or implant infection were sonicated separately in sterile containers to dislodge the adherent bacteria from the surfaces and cultured. The results of sonication culture were compared to the conventional tissue culture. We investigated 60 consecutive patients with loosening of the prostheses or implants Forty patients had septic and 20 aseptic loosening (24 knee prostheses, 21 hip prostheses, 6 mega-prostheses, 2 shoulder prostheses, 6 osteosynthesis, 1 spinal instrumentation). The sensitivity of sonication fluid culture was 83.3%, of single positive tissue culture was 72.2% and 61.1% when two or more cultures yielded the same microorganism. In patients receiving antibiotic therapy the sensitivity was 65.9%, 57.5%, and 42.5%, respectively. Pathogens detected in a single tissue culture as well as in sonication culture yielded a significantly higher rate of prosthetic infection than conventional tissue culture alone (p = 0.008), even in patients receiving continuous antibiotic therapy before explantation (p = 0.016). The sonication method represents an essential add-on in pathogen detection compared to conventional tissue culture.
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Affiliation(s)
- Johannes Holinka
- Department of Orthopaedic Surgery, Medical University of Vienna, General Hospital, Vienna, Austria.
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HØGDALL DAN, HVOLRIS JØRGENJESPER, CHRISTENSEN LISE. Improved detection methods for infected hip joint prostheses. APMIS 2010; 118:815-23. [DOI: 10.1111/j.1600-0463.2010.02671.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kobayashi N, Inaba Y, Choe H, Aoki C, Ike H, Ishida T, Iwamoto N, Yukizawa Y, Saito T. Simultaneous intraoperative detection of methicillin-resistant Staphylococcus and pan-bacterial infection during revision surgery: use of simple DNA release by ultrasonication and real-time polymerase chain reaction. J Bone Joint Surg Am 2009; 91:2896-902. [PMID: 19952253 DOI: 10.2106/jbjs.i.00119] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Periprosthetic infection is one of the most serious complications of arthroplasty, and low-grade infections are particularly difficult to diagnose with use of conventional culture methods. Real-time polymerase chain reaction is a potentially viable way to overcome this detection problem as it is a more rapid and sensitive technique. In the current study, we used intraoperative polymerase chain reaction identification combined with a simple DNA-release method with ultrasonication to diagnose periprosthetic infections during revision surgery. METHODS Thirty revision arthroplasty procedures were included in this prospective study. Surgical specimens were obtained intraoperatively, treated with ultrasonication, and then analyzed with real-time polymerase chain reaction. Methicillin-resistant Staphylococcus-specific polymerase chain reaction and 16S rRNA gene universal polymerase chain reaction were performed simultaneously to facilitate both specific and broad-range detection. Specimens obtained from the same sites were also analyzed with microbiologic culture and histopathological evaluation. RESULTS The specific polymerase chain reaction revealed methicillin-resistant Staphylococcus infection in specimens from six of the thirty operations analyzed in the present study, and the 16S rRNA gene universal polymerase chain reaction analysis was positive for specimens from thirteen operations. Conventional cultures revealed six methicillin-resistant Staphylococcus infections, two Staphylococcus aureus infections, one infection with another Staphylococcus species, and two Streptococcus infections. The sensitivity of the polymerase chain reaction method was 0.87 and the specificity was 0.8 when compared with the combined results of microbiologic culture and histopathological evaluation. CONCLUSIONS The ultrasonication method that we developed for accelerated DNA sample preparation as a replacement for conventional extraction made possible the potential intraoperative identification of periprosthetic infection during revision surgery. The simultaneous detection of methicillin-resistant Staphylococcus and broad-range bacterial infections would be invaluable for the informed selection of antibiotics and also for the formulation of the subsequent treatment strategy (a one-stage or two-stage revision) for the patient.
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Affiliation(s)
- Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
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In vitro effect of ultrasound on bacteria and suggested protocol for sonication and diagnosis of prosthetic infections. J Clin Microbiol 2009; 47:2496-501. [PMID: 19535525 DOI: 10.1128/jcm.02316-08] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Sonication of implants has been shown to be a promising method for diagnosis of prosthetic infections due to its improved sensitivity, simplicity, and low cost. The aim of the present study was to evaluate the effects of ultrasound performed under different conditions regarding temperature, duration, and composition of sonication tubes on bacterial species often associated with prosthetic infections. We found that ultrasound had an inhibitory effect on bacteria, of which gram-negative bacteria, in particular Escherichia coli, were almost eradicated after 5 min of sonication at 35 degrees C. Gram-positive bacteria were found to be resistant to the effect of ultrasound. Four factors were important for the inhibitory effect of sonication: the type of microorganism, the temperature of the sonication buffer, the duration of exposure to ultrasound (minutes), and the material and composition of the sonication tube in which sonication is performed. On the basis of the results from the present study, we propose a protocol for sonication and recovery of bacteria associated with biofilm on infected implants prior to conventional culture. From the present protocol, we recommend sonication for 7 min at 22 degrees C at the maximum effect which permits survival of gram-negative bacteria.
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Improved detection of biofilm-formative bacteria by vortexing and sonication: a pilot study. Clin Orthop Relat Res 2009; 467:1360-4. [PMID: 18989729 PMCID: PMC2664413 DOI: 10.1007/s11999-008-0609-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 10/21/2008] [Indexed: 01/31/2023]
Abstract
Bacteria such as staphylococci commonly encountered in orthopaedic infections form biofilms and adhere to bone implants and cements. Various methods to disrupt the biofilm and enhance bacterial detection have been reported. We will describe the effectiveness of vortexing and sonication to improve the detection of biofilm-formative bacteria from polymethylmethacrylate by conventional quantitative bacterial culture and real-time quantitative PCR. We used a single biofilm-formative Staphylococcus aureus strain and 20 polymethylmethacrylate coupons as an in vitro biofilm model; four coupons were used for each of two control groups or three experimental sonication times (1, 5, and 30 minutes). Vortexing the cement without sonication increased the yield of adherent bacteria to a considerable extent. The combination of vortexing and sonication further enhanced the yield regardless of the duration of sonication. Quantitative conventional cultures correlated with quantitative PCR assay. The combination of vortexing and sonication to disrupt the bacterial biofilm followed by quantitative PCR and/or culture seems to be a sensitive method for detecting bacteria adherent to bone cement.
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Bjerkan G, Witsø E, Bergh K. Sonication is superior to scraping for retrieval of bacteria in biofilm on titanium and steel surfaces in vitro. Acta Orthop 2009; 80:245-50. [PMID: 19404811 PMCID: PMC2823171 DOI: 10.3109/17453670902947457] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Low-virulence implant infections are characterized by bacterial colonization of the implant with subsequent biofilm formation. In these cases, soft tissue biopsies often prove to be culture negative. Consequently, detachment of the causative adherent bacteria is crucial for correct microbiological diagnosis. Using an in vitro model, we compared 4 methods of biofilm sampling from metal surfaces. METHODS Discs of titanium and steel were incubated in the presence of Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, and Propionibacterium acnes in Mueller Hinton broth. Non-adherent bacteria were removed by repeated rinsing of the discs. 10 parallels of each disc were subjected to 1 of 4 methods for bacterial recovery: (A) sonication of the discs, (B) scraping of the discs using surgical blades followed by streaking of the blades onto agar plates, (C) scraping of the discs followed by vortex mixing of the surgical blades, and (D) scraping of the discs followed by sonication of the surgical blades. Quantitative bacterial cultures were performed for each sampling method. RESULTS With the exception of S. epidermidis on steel, sonication efficiently and reliably dislodged biofilm bacteria. The scraping methods employed did not detach bacteria embedded in biofilm. INTERPRETATION Scraping of metal surfaces is not an adequate method for sampling of biofilm bacteria in vitro.
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Affiliation(s)
- Geir Bjerkan
- Department of Orthopaedic Surgery, St Olav's University Hospital, Trondheim, Norway.
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Fujimura S, Sato T, Mikami T, Kikuchi T, Gomi K, Watanabe A. Combined efficacy of clarithromycin plus cefazolin or vancomycin against Staphylococcus aureus biofilms formed on titanium medical devices. Int J Antimicrob Agents 2008; 32:481-4. [DOI: 10.1016/j.ijantimicag.2008.06.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 06/20/2008] [Accepted: 06/23/2008] [Indexed: 11/16/2022]
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Kobayashi N, Procop GW, Krebs V, Kobayashi H, Bauer TW. Molecular identification of bacteria from aseptically loose implants. Clin Orthop Relat Res 2008; 466:1716-25. [PMID: 18438724 PMCID: PMC2505246 DOI: 10.1007/s11999-008-0263-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2007] [Accepted: 04/07/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Polymerase chain reaction (PCR) assays have been used to detect bacteria adherent to failed orthopaedic implants, but some PCR assays have had problems with probable false-positive results. We used a combination of a Staphylococcus species-specific PCR and a universal PCR followed by DNA sequencing to identify bacteria on implants retrieved from 52 patients (92 implants) at revision arthroplasty. We addressed two questions in this study: (1) Is this method able to show the existence of bacterial DNA on presumed aseptic loosed implants?; and (2) What proportion of presumed aseptic or culture-negative implants was positive for bacterial DNA by PCR? Fourteen implants (15%) were believed infected, whereas 74 implants (85%) were believed aseptic. Each implant was sonicated and the resulting solution was submitted for dual real-time PCR assay and culture. All implants believed aseptically loose were culture-negative, but nine of the 74 (12%) had bacterial DNA by PCR; two (2.7%) were PCR-positive and also showed histologic findings suggestive of infection. Uniquely developed PCR and bacterial sequencing assays showed bacterial DNA on 12% of implants removed for presumed aseptic loosening. Additional studies are needed to determine the clinical importance of bacterial DNA detected by PCR but not by conventional culture. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Naomi Kobayashi
- Department of Anatomic Pathology, L25, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH USA
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Gary W. Procop
- Department of Clinical Microbiology, The Cleveland Clinic Foundation, Cleveland, OH USA
| | - Viktor Krebs
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH USA
| | - Hideo Kobayashi
- Department of Anatomic Pathology, L25, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH USA
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Thomas W. Bauer
- Department of Anatomic Pathology, L25, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195 USA
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH USA
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Beckmann J, Kees F, Schaumburger J, Kalteis T, Lehn N, Grifka J, Lerch K. Tissue concentrations of vancomycin and Moxifloxacin in periprosthetic infection in rats. Acta Orthop 2007; 78:766-73. [PMID: 18236182 DOI: 10.1080/17453670710014536] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A one-step exchange of an endoprosthesis with periprosthetic infection requires effective antibiotics at high concentrations around the endoprosthesis. We evaluated the tissue distribution of vancomycin and Moxifloxacin in a standardized in vivo model of periprosthetic infection. METHODS 36 male rats with periprosthetic infection of the left hind leg, induced by a standardized procedure, received either antibiotic treatment with vancomycin or Moxifloxacin twice daily for 2 weeks, or a sham treatment. After the last administration, different tissues from each animal were evaluated for concentrations of antibiotic. RESULTS Compared to plasma, the tissue concentrations of Moxifloxacin were higher in all tissues investigated (lung, muscle, fat, bone) and the tissue-plasma ratio of Moxifloxacin was considerably higher than that of vancomycin. The concentrations of Moxifloxacin were equally high in the infected and the uninfected hind leg, whereas the vancomycin concentrations were significantly higher in the infected leg. INTERPRETATION The standardized model of periprosthetic infection described here can be extrapolated to different bacterial and mycotic pathogens, and also to different antibiotics or therapeutic regimes. It provides a way of correlating tissue concentrations with clinical outcome in future studies.
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Affiliation(s)
- Johannes Beckmann
- Department of Orthopedic Surgery, Institute of Medical Microbiology and Hygiene, University of Regensburg, Landshut, Germany.
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Nilsdotter-Augustinsson A, Briheim G, Herder A, Ljunghusen O, Wahlström O, Ohman L. Inflammatory response in 85 patients with loosened hip prostheses: a prospective study comparing inflammatory markers in patients with aseptic and septic prosthetic loosening. Acta Orthop 2007; 78:629-39. [PMID: 17966022 DOI: 10.1080/17453670710014329] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The most common complications of prosthetic hip joints are aseptic mechanical failure and infection. Delayed low-grade infections are seen most often, and they are also most difficult to distinguish from aseptic mechanical failures. METHODS We conducted a prospective study to compare inflammatory markers in patients diagnosed with aseptic or septic prosthetic loosening. The diagnostic criteria were based on the decisions of experienced orthopedic surgeons and microbiological analysis of periprosthetic tissue samples taken perioperatively. RESULTS Coagulase-negative staphylococci were the commonest pathogens in the infected patients. Pre- or perioperative elevation of C-reactive protein and erythrocyte sedimentation rate were significantly greater in the infection group, as were white blood cell count and levels of cytokines in synovial fluid. The patterns of infiltration of inflammatory cells in periprosthetic tissue were also significantly different between the groups. INTERPRETATION A combination of clinical judgment and multiple tissue samples constitutes a good platform for distinguishing between septic and aseptic loosening of prostheses. Moreover, the combined use of several laboratory and histopathological markers of inflammation, especially infiltration of polymorphonuclear cells, further helps the diagnosis.
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Kobayashi N, Bauer TW, Tuohy MJ, Fujishiro T, Procop GW. Brief ultrasonication improves detection of biofilm-formative bacteria around a metal implant. Clin Orthop Relat Res 2007; 457:210-3. [PMID: 17195819 DOI: 10.1097/blo.0b013e3180312042] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Biofilms are complex microenvironments produced by microorganisms on surfaces. Ultrasonication disrupts biofilms and may make the microorganism or its DNA available for detection. We determined whether ultrasonication could affect our ability to detect bacteria adherent to a metal substrate. A biofilm-formative Staphylococcus aureus strain was used for an in vitro implant infection model (biofilm-formative condition). We used quantitative culture and real time-polymerase chain reaction to determine the influence of different durations of ultrasound on bacterial adherence and viability. Sonication for 1 minute increased the yield of bacteria. Sonication longer than 5 minutes led to fewer bacterial colonies by conventional culture but not by polymerase chain reaction. This suggests short periods of sonication help release bacteria from the metal substrate by disrupting the biofilm, but longer periods of sonication lyse bacteria prohibiting their detection in microbiologic cultures. A relatively short duration of sonication may be desirable for maximizing detection of biofilm-formative bacteria around implants by culture or polymerase chain reaction.
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Affiliation(s)
- Naomi Kobayashi
- Department of Anatomic Pathology, The Cleveland Clinic, OH 44195-5138, USA
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Kobayashi N, Bauer TW, Tuohy MJ, Lieberman IH, Krebs V, Togawa D, Fujishiro T, Procop GW. The comparison of pyrosequencing molecular Gram stain, culture, and conventional Gram stain for diagnosing orthopaedic infections. J Orthop Res 2006; 24:1641-9. [PMID: 16788984 DOI: 10.1002/jor.20202] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We have developed a combined real-time PCR and pyrosequencing assay that successfully differentiated the vast majority of gram-positive and gram-negative bacteria when bacterial isolates were tested. The purpose of this study was to evaluate this assay on clinical specimens obtained from orthopedic surgeries, and to prospectively compare the results of "molecular Gram stain" with culture and conventional direct Gram stain. Forty-five surgical specimens were obtained from patients who underwent orthopedic surgery procedures. The DNA was extracted and a set of broad-range PCR primers that targeted a part of the 16S rDNA gene was used for pan-bacterial PCR. The amplicons were submitted for pyrosequencing and the resulting molecular Gram stain characteristics were recorded. Culture and direct Gram staining were performed using standard methods for all cases. Surgical specimens were reviewed histologically for all cases that had a discrepancy between culture and molecular results. There was an 86.7% (39/45) agreement between the traditional and molecular methods. In 12/14 (85.7%) culture-proven cases of bacterial infection, molecular Gram stain characteristics were in agreement with the culture results, while the conventional Gram stain result was in agreement only for five cases (35.7%). In the 31 culture negative cases, 27 cases were also PCR negative, whereas 4 were PCR positive. Three of these were characterized as gram negative and one as gram positive by this molecular method. Molecular determination of the Gram stain characteristics of bacteria that cause orthopedic infections may be achieved, in most instances, by this method. Further studies are necessary to understand the clinical importance of PCR-positive/culture-negative results.
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Affiliation(s)
- Naomi Kobayashi
- Department of Anatomic Pathology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
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Trampuz A, Piper KE, Hanssen AD, Osmon DR, Cockerill FR, Steckelberg JM, Patel R. Sonication of explanted prosthetic components in bags for diagnosis of prosthetic joint infection is associated with risk of contamination. J Clin Microbiol 2006; 44:628-31. [PMID: 16455930 PMCID: PMC1392705 DOI: 10.1128/jcm.44.2.628-631.2006] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Explanted orthopedic implants from 54 patients with aseptic failure and 24 patients with prosthetic knee or hip infection were sonicated in polyethylene bags. The sensitivities of periprosthetic tissue and sonicate fluid cultures for the diagnosis of prosthetic joint infection were 54% and 75%, whereas the specificities were 98% and 87%, respectively. Sonication in bags improved bacterial recovery from the surface of orthopedic implants; however, it lacked specificity, due to bag leakage.
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Affiliation(s)
- Andrej Trampuz
- Division of Infectious Diseases, Mayo Clinic College of Medicine, 200 First St. S.W., Rochester, MN 55905, USA
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Hak DJ, Wiater PJ, Williams RM, Pierson CL. The effectiveness of standard povidone iodine surgical preparation in decontaminating external fixator components. Injury 2005; 36:1449-52. [PMID: 16243337 DOI: 10.1016/j.injury.2005.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Revised: 05/07/2005] [Accepted: 05/11/2005] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to evaluate the effectiveness of standard iodine surgical scrubs to remove bacteria from external fixator components. Sterile adjustable external fixation clamps, Schanz pins, and carbon fibre rods were coated with a sterile protein solution and immersed in solution of coagulase negative Staphylococcus (10(3)organisms/ml). They were then decontaminated in standard fashion using a povidone iodine scrub and paint solution. After neutralisation the components were sonicated, serially diluted, plated on blood agar, and incubated for 24h. Unassembled external fixation components were examined individually, and as assembled pin-rod-clamp constructs with and without manipulation of the clamp. Of the three external fixation components (pins, rods, clamps) the highest number of bacterial colony forming units was seen on the external fixation clamps. Manipulation of the assembled construct significantly increased the mean bacterial colony counts compared to the assembled non-manipulated construct (p=0.0007). Standard surgical preparation does not remove all bacteria from external fixators during subsequent operative procedures.
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Affiliation(s)
- David J Hak
- The University of California at Davis, Department of Orthopaedic Surgery, 4860 Y Street, Suite 3800, Sacramento, CA 95817, USA.
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Duffy PJ, Masri BA, Garbuz DS, Duncan CP. Evaluation of patients with pain following total hip replacement. J Bone Joint Surg Am 2005; 87:2566-75. [PMID: 16294463 DOI: 10.2106/00004623-200511000-00026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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