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Improved identification of polymicrobial infection in total knee arthroplasty through sonicate fluid cultures

  • Knee Revision Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Periprosthetic joint infection (PJI) is the leading cause for early failure of total knee arthroplasty (TKA). An insufficient diagnosis of the involved bacterial species can be a possible cause for this high failure rate. Sonicate fluid cultures (SFC) have been shown to increase the detection rate of PJI in comparison to the use of conventional microbiological methods. The hypothesis of this study is that sonication will improve not only the detection rate of PJI, but also the detection rate of polymicrobial infection in patients with TKA revision surgery.

Materials and methods

109 patients, undergoing TKA revision surgery, were enrolled in this prospective cohort study and received a synovial aspiration, intraoperative tissue cultures, histological sampling of the periprosthetic membrane (PM), and sonication of the explanted endoprosthesis. A PJI was defined according to the following criteria: presence of intraarticular pus or a sinus tract, positive isolation of the same bacterial species in ≥2 microbiological samples or a PM indicative of infection.

Results

31 patients had a defined PJI according to the above-mentioned criteria. SFC achieved the highest sensitivity (74 %) of all microbiological methods. The PM achieved a sensitivity of 87 %. When the results of the SFC and the PM were combined, it was possible to further increase the sensitivity to 94 %. The utilization of SFC doubled the number of polymicrobial bacterial isolations in our patient collective. There were 12 cases of polymicrobial bacterial isolations, six were detectable through conventional microbiological methods, four were detectable through SFC and two were identifiable as polymicrobial through the isolation of an additional bacterial species in the SFC.

Conclusions

In our study, SFC were the most sensitive microbiological method and were surpassed only by the histology. The use of SFC doubled the detection rate of polymicrobial isolations, which would be missed with conventional microbiological methods alone.

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Acknowledgments

All authors declare no professional or financial affiliations that pose a potential conflict of interest or bias to this study.

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Authors and Affiliations

  1. Orthopaedic Department, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    V. Janz, G. I. Wassilew, A. Trampuz & C. Perka

  2. Department for Trauma, Hand and Reconstruction Surgery, Universitätsklinikum Jena, Erlanger Allee 101, 07749, Jena, Germany

    M. Kribus

Authors
  1. V. Janz
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  2. G. I. Wassilew
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  3. M. Kribus
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  4. A. Trampuz
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  5. C. Perka
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Correspondence to V. Janz.

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Janz, V., Wassilew, G.I., Kribus, M. et al. Improved identification of polymicrobial infection in total knee arthroplasty through sonicate fluid cultures. Arch Orthop Trauma Surg 135, 1453–1457 (2015). https://doi.org/10.1007/s00402-015-2317-4

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  • DOI: https://doi.org/10.1007/s00402-015-2317-4

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