novel-diagnostics-revision-arthroplasty-implant-sonication-multiplex

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of ...

University Hospital Bonn

Pantoea agglomerans is a rare isolate in orthopaedic patients. We describe the first case of an acute hip prosthetic joint infection (PJI) caused by Pantoea agglomerans. The microorganism was detected after sonication of the removed hip endoprosthesis.

Detection of Pantoea agglomerans in hip prosthetic infection by sonication of the removed prosthesis: the first reported case.

Fusobacterium nucleatum is a strict anaerobic microorganism that causes disease entities such as periodontal and soft tissue abscesses, pulmonary and intraabdominal infections and very rarely intracerebral infections.

Rapid brain death caused by a cerebellar abscess with Fusobacterium nucleatum in a young man with drug abuse: a case report.

Acinetobacter baumannii is an emerging nosocomial pathogen primarily in countries with a high prevalence of multidrug resistance. Here we report the detection of a bla OXA23 carbapenemase-producing A. baumannii strain in a German patient with prosthetic hip joint infection following several hip joint surgeries but no history of foreign travel.

Multidrug resistant Acinetobacter baumannii reaches a new frontier: prosthetic hip joint infection.

Prosthetic joint infections (PJI) are a serious and challenging complication after total joint arthroplasty. According to the literature, most PJI are monomicrobial infections caused by gram-positive cocci. The number of polymicrobial PJI might be underrepresented in the literature and only limited data are available regarding the outcome of polymicrobial PJI. Our hypothesis was that polymicrobial PJI are associated with a reduced cure rate compared with monomicrobial PJI.

Polymicrobial infections reduce the cure rate in prosthetic joint infections: outcome analysis with two-stage exchange and follow-up ≥two years.

Total joint arthroplasty is a common operation worldwide with infection rates between 1% and 3%. In cases of suspected periprosthetic joint infection, it is very challenging to rule out the causative microorganisms. In this study, we compared the appearance of periprosthetic membranes with the microbiological results obtained from cultures of sonication fluid and the correlation between classical microbiological cultures and cultures of sonication fluid. The results confirmed a strong correlation of bacterial growth in sonication fluid cultures with bacterial growth in classical microbiological cultures. Most importantly, however, our study documented a highly significant correlation of periprosthetic membranes typical for periprosthetic joint infection (PJI) with bacterial growth in sonication fluid. Sonication fluid cultures yielded a better sensitivity than tissue cultures (72.34-60.87%). These 3 methods are useful tools in diagnosing PJIs, and even more, sonication fluid cultures should be included in the diagnostic path of PJI.

Comparison of bacterial growth in sonication fluid cultures with periprosthetic membranes and with cultures of biopsies for diagnosing periprosthetic joint infection.

Periprosthetic joint infection (PJI) is one of the most challenging complications in orthopedic surgery. In cases of suspected periprosthetic joint infection several diagnostic methods are available. In this study we investigated the performance of the newly available Unyvero i60 implant and tissue infection (ITI) multiplex PCR System. 62 specimens from 31 patients with suspected PJI or aseptic loosening of a painful joint arthoplasty were included in this study. Besides the established diagnostic procedures we included a commercial multiplex PCR detection system for diagnosis of PJI. The PCR results obtained from analysis of sonication and synovial fluids (62 specimens) showed a sensitivity of 66.7%, a specificity of 100%, a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 68.4% when compared to cultural methods. Notably, cultures from sonication fluid displayed a sensitivity of 88.9%, a specificity of 61.5%, a PPV of 76.2% and a NPV of 80.0% when compared to tissue cultures. In conclusion, multiplex PCR is an additional - rapid - method for diagnosing PJI. Positive results with the PCR assay used in this study were always confirmed by subsequent matching culture positivity. However, apart from the time saved the nucleic acid amplification technique did not yield additional information than that obtained from microbiological cultures.

Article	Year
Detection of Pantoea agglomerans in hip prosthetic infection by sonication of the removed prosthesis: the first reported case. Technology and health care : official journal of the European Society for Engineering and Medicine\| PubMed ID: 24225410	2013
Rapid brain death caused by a cerebellar abscess with Fusobacterium nucleatum in a young man with drug abuse: a case report. BMC research notes\| PubMed ID: 24915846	2014
Multidrug resistant Acinetobacter baumannii reaches a new frontier: prosthetic hip joint infection. Infection\| PubMed ID: 25037735	2015
Polymicrobial infections reduce the cure rate in prosthetic joint infections: outcome analysis with two-stage exchange and follow-up ≥two years. International orthopaedics\| PubMed ID: 26183140	2016
Comparison of bacterial growth in sonication fluid cultures with periprosthetic membranes and with cultures of biopsies for diagnosing periprosthetic joint infection. Diagnostic microbiology and infectious disease\| PubMed ID: 26584961	2016
Unyvero i60 implant and tissue infection (ITI) multiplex PCR system in diagnosing periprosthetic joint infection. Journal of microbiological methods\| PubMed ID: 26689142	2016

Gunnar T.R. Hischebeth

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