The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive.

<h4>Background</h4>In the absence of a gold standard criterion for diagnosing prosthetic joint infections (PJI), sonication of the removed implant may provide superior microbiological identification to synovial fluid and peri-implant tissue cultures. The aim of this retrospective study w...

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Autores principales:	Taiana Cunha Ribeiro, Emerson Kiyoshi Honda, Daniel Daniachi, Ricardo de Paula Leite Cury, Cely Barreto da Silva, Giselle Burlamaqui Klautau, Mauro Jose Salles
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/cefdc5046fd74ee6b3cb1f23fe9e3f7a
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spelling	oai:doaj.org-article:cefdc5046fd74ee6b3cb1f23fe9e3f7a2021-12-02T20:05:05ZThe impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive.1932-620310.1371/journal.pone.0252322https://doaj.org/article/cefdc5046fd74ee6b3cb1f23fe9e3f7a2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252322https://doaj.org/toc/1932-6203<h4>Background</h4>In the absence of a gold standard criterion for diagnosing prosthetic joint infections (PJI), sonication of the removed implant may provide superior microbiological identification to synovial fluid and peri-implant tissue cultures. The aim of this retrospective study was to assess the role of sonication culture compared to tissue cultures for diagnosing PJI, using different consensus and international guidelines for PJI definition.<h4>Methods</h4>Data of 146 patients undergoing removal of hip or knee arthroplasties between 2010 and 2018 were retrospectively reviewed. The International Consensus Meeting (ICM-2018), Musculoskeletal Infection Society (MSIS), Infectious Diseases Society of America (IDSA), the European Bone and Joint Infection Society (EBJIS), and a modified clinical criterion, were used to compare the performance of microbiological tests. McNemar´s test and proportion comparison were employed to calculate p-value.<h4>Results</h4>Overall, 56% (82/146) were diagnosed with PJI using the clinical criteria. Out of these cases, 57% (47/82) tested positive on tissue culture and 93% (76/82) on sonication culture. Applying this clinical criterion, the sensitivity of sonication fluid and tissue cultures was 92.7% (95% CI: 87.1%- 98.3%) and 57.3% (95% CI: 46.6%-68.0%) (p<0.001), respectively. When both methods were combined for diagnosis (sonication and tissue cultures) sensitivity reached 96.3% (95% CI: 91.5%-100%). Sonication culture and the combination of sonication with tissue cultures, showed higher sensitivity rates than tissue cultures alone for all diagnostic criteria (ICM-18, MSIS, IDSA and EBJIS) applied. Conversely, tissue culture provided greater specificity than sonication culture for all the criteria assessed, except for the EBJIS criteria, in which sonication and tissue cultures specificity was 100% and 95.3% (95% CI: 87.8-100%), respectively (p = 0.024).<h4>Conclusions</h4>In a context where diagnostic criteria available have shortcomings and tissue cultures remain the gold standard, sonication cultures can aid PJI diagnosis, especially when diagnostic criteria are inconclusive due to some important missing data (joint puncture, histology).Taiana Cunha RibeiroEmerson Kiyoshi HondaDaniel DaniachiRicardo de Paula Leite CuryCely Barreto da SilvaGiselle Burlamaqui KlautauMauro Jose SallesPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0252322 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Taiana Cunha Ribeiro Emerson Kiyoshi Honda Daniel Daniachi Ricardo de Paula Leite Cury Cely Barreto da Silva Giselle Burlamaqui Klautau Mauro Jose Salles The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive.
description	<h4>Background</h4>In the absence of a gold standard criterion for diagnosing prosthetic joint infections (PJI), sonication of the removed implant may provide superior microbiological identification to synovial fluid and peri-implant tissue cultures. The aim of this retrospective study was to assess the role of sonication culture compared to tissue cultures for diagnosing PJI, using different consensus and international guidelines for PJI definition.<h4>Methods</h4>Data of 146 patients undergoing removal of hip or knee arthroplasties between 2010 and 2018 were retrospectively reviewed. The International Consensus Meeting (ICM-2018), Musculoskeletal Infection Society (MSIS), Infectious Diseases Society of America (IDSA), the European Bone and Joint Infection Society (EBJIS), and a modified clinical criterion, were used to compare the performance of microbiological tests. McNemar´s test and proportion comparison were employed to calculate p-value.<h4>Results</h4>Overall, 56% (82/146) were diagnosed with PJI using the clinical criteria. Out of these cases, 57% (47/82) tested positive on tissue culture and 93% (76/82) on sonication culture. Applying this clinical criterion, the sensitivity of sonication fluid and tissue cultures was 92.7% (95% CI: 87.1%- 98.3%) and 57.3% (95% CI: 46.6%-68.0%) (p<0.001), respectively. When both methods were combined for diagnosis (sonication and tissue cultures) sensitivity reached 96.3% (95% CI: 91.5%-100%). Sonication culture and the combination of sonication with tissue cultures, showed higher sensitivity rates than tissue cultures alone for all diagnostic criteria (ICM-18, MSIS, IDSA and EBJIS) applied. Conversely, tissue culture provided greater specificity than sonication culture for all the criteria assessed, except for the EBJIS criteria, in which sonication and tissue cultures specificity was 100% and 95.3% (95% CI: 87.8-100%), respectively (p = 0.024).<h4>Conclusions</h4>In a context where diagnostic criteria available have shortcomings and tissue cultures remain the gold standard, sonication cultures can aid PJI diagnosis, especially when diagnostic criteria are inconclusive due to some important missing data (joint puncture, histology).
format	article
author	Taiana Cunha Ribeiro Emerson Kiyoshi Honda Daniel Daniachi Ricardo de Paula Leite Cury Cely Barreto da Silva Giselle Burlamaqui Klautau Mauro Jose Salles
author_facet	Taiana Cunha Ribeiro Emerson Kiyoshi Honda Daniel Daniachi Ricardo de Paula Leite Cury Cely Barreto da Silva Giselle Burlamaqui Klautau Mauro Jose Salles
author_sort	Taiana Cunha Ribeiro
title	The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive.
title_short	The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive.
title_full	The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive.
title_fullStr	The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive.
title_full_unstemmed	The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive.
title_sort	impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/cefdc5046fd74ee6b3cb1f23fe9e3f7a
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The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive.

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