This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Atkins, B. L.
Right arrow Articles by Group, T. O. C. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Atkins, B. L.
Right arrow Articles by Group, T. O. C. S.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, October 1998, p. 2932-2939, Vol. 36, No. 10
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Prospective Evaluation of Criteria for Microbiological Diagnosis of Prosthetic-Joint Infection at Revision Arthroplasty

Bridget L. Atkins,1,2 Nicholas Athanasou,3,4 Jonathan J. Deeks,5 Derrick W. M. Crook,2 Hamish Simpson,4,6 Timothy E. A. Peto,2 Peter McLardy-Smith,4 Anthony R. Berendt,2,4,* and The Osiris Collaborative Study Groupdagger

Public Health Laboratory,1 Department of Pathology,3 Nuffield Department of Orthopaedic Surgery,6 and Bone Infection Unit,4 Nuffield Orthopaedic Centre, Academic Unit of Microbiology and Infectious Diseases, John Radcliffe Hospital,2 and Centre for Statistics in Medicine, Institute of Health Sciences,5 Oxford, United Kingdom

Received 6 February 1998/Returned for modification 30 March 1998/Accepted 30 June 1998

A prospective study was performed to establish criteria for the microbiological diagnosis of prosthetic joint infection at elective revision arthroplasty. Patients were treated in a multidisciplinary unit dedicated to the management and study of musculoskeletal infection. Standard multiple samples of periprosthetic tissue were obtained at surgery, Gram stained, and cultured by direct and enrichment methods. With reference to histology as the criterion standard, sensitivities, specificities, and likelihood ratios (LRs) were calculated by using different cutoffs for the diagnosis of infection. We performed revisions on 334 patients over a 17-month period, of whom 297 were evaluable. The remaining 37 were excluded because histology results were unavailable or could not be interpreted due to underlying inflammatory joint disease. There were 41 infections, with only 65% of all samples sent from infected patients being culture positive, suggesting low numbers of bacteria in the samples taken. The isolation of an indistinguishable microorganism from three or more independent specimens was highly predictive of infection (sensitivity, 65%; specificity, 99.6%; LR, 168.6), while Gram staining was less useful (sensitivity, 12%; specificity, 98%; LR, 10). A simple mathematical model was developed to predict the performance of the diagnostic test. We recommend that five or six specimens be sent, that the cutoff for a definite diagnosis of infection be three or more operative specimens that yield an indistinguishable organism, and that because of its low level of sensitivity, Gram staining should be abandoned as a diagnostic tool at elective revision arthroplasty.

* Corresponding author. Mailing address: Bone Infection Unit, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, United Kingdom. Phone: 00 44 1865 227779. Fax: 00 44 1865 227740. E-mail: tony.berendt{at}noc.anglox.nhs.uk.

dagger The members of the OSIRIS (Oxford Skeletal Infection Research and Intervention Service) Collaboration Study Group are M. Benson, A. Carr, D. Collopy, P. Cooke, J. Kenwright, P. McClardy-Smith, H. Simpson, R. de Steiger, R. Gundle, K. Willett, B. Atkins, A. Berendt, I. Bowler, C. Conlon, D. Crook, A. Emptage, T. Peto, J. Deeks, and N. Athanasou.

Journal of Clinical Microbiology, October 1998, p. 2932-2939, Vol. 36, No. 10
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


This article has been cited by other articles:

  • Morgan, P. M., Sharkey, P., Ghanem, E., Parvizi, J., Clohisy, J. C., Burnett, R. S. J., Barrack, R. L. (2009). The Value of Intraoperative Gram Stain in Revision Total Knee Arthroplasty. JBJS 91: 2124-2129 [Abstract] [Full Text]  
  • Del Pozo, J. L., Patel, R. (2009). Infection Associated with Prosthetic Joints. NEJM 361: 787-794 [Full Text]  
  • Sivadon, V., Rottman, M., Quincampoix, J.-C., Prunier, E., Le Moal, M., de Mazancourt, P., Hoffmeyer, P., Lortat-Jacob, A., Piriou, P., Judet, T., Bernard, L., Gaillard, J.-L. (2009). Partial atlE Sequencing of Staphylococcus epidermidis Strains from Prosthetic Joint Infections. J. Clin. Microbiol. 47: 2321-2324 [Abstract] [Full Text]  
  • Piper, K. E., Jacobson, M. J., Cofield, R. H., Sperling, J. W., Sanchez-Sotelo, J., Osmon, D. R., McDowell, A., Patrick, S., Steckelberg, J. M., Mandrekar, J. N., Fernandez Sampedro, M., Patel, R. (2009). Microbiologic Diagnosis of Prosthetic Shoulder Infection by Use of Implant Sonication. J. Clin. Microbiol. 47: 1878-1884 [Abstract] [Full Text]  
  • Byren, I., Bejon, P., Atkins, B. L., Angus, B., Masters, S., McLardy-Smith, P., Gundle, R., Berendt, A. (2009). One hundred and twelve infected arthroplasties treated with 'DAIR' (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother 63: 1264-1271 [Abstract] [Full Text]  
  • Loiez, C., Tavani, F., Wallet, F., Flahaut, B., Senneville, E., Girard, J., Courcol, R. J. (2009). An unusual case of prosthetic joint infection due to Arcanobacterium bernardiae. J Med Microbiol 58: 842-843 [Full Text]  
  • Matthews, P. C, Berendt, A. R, McNally, M. A, Byren, I. (2009). Diagnosis and management of prosthetic joint infection. BMJ 338: b1773-b1773 [Full Text]  
  • Lattar, S. M., Tuchscherr, L. P. N., Caccuri, R. L., Centron, D., Becker, K., Alonso, C. A., Barberis, C., Miranda, G., Buzzola, F. R., von Eiff, C., Sordelli, D. O. (2009). Capsule Expression and Genotypic Differences among Staphylococcus aureus Isolates from Patients with Chronic or Acute Osteomyelitis. Infect. Immun. 77: 1968-1975 [Abstract] [Full Text]  
  • Whittaker, J. P., Warren, R. E., Jones, R. S., Gregson, P. A. (2009). Is prolonged systemic antibiotic treatment essential in two-stage revision hip replacement for chronic Gram-positive infection?. J Bone Joint Surg Br 91-B: 44-51 [Abstract] [Full Text]  
  • Vandercam, B., Jeumont, S., Cornu, O., Yombi, J.-C., Lecouvet, F., Lefevre, P., Irenge, L. M., Gala, J.-L. (2008). Amplification-Based DNA Analysis in the Diagnosis of Prosthetic Joint Infection. J. Mol. Diagn. 10: 537-543 [Abstract] [Full Text]  
  • Munoz, P., Bouza, E., Marin, M., Alcala, L., Rodriguez Creixems, M., Valerio, M., Pinto, A., on behalf of the Group for the Management of Infec, (2008). Heart Valves Should Not Be Routinely Cultured. J. Clin. Microbiol. 46: 2897-2901 [Abstract] [Full Text]  
  • Fink, B., Makowiak, C., Fuerst, M., Berger, I., Schafer, P., Frommelt, L. (2008). The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg Br 90-B: 874-878 [Abstract] [Full Text]  
  • Mandalia, V., Eyres, K., Schranz, P., Toms, A. D. (2008). Evaluation of patients with a painful total knee replacement. J Bone Joint Surg Br 90-B: 265-271 [Abstract] [Full Text]  
  • Trampuz, A., Piper, K. E., Jacobson, M. J., Hanssen, A. D., Unni, K. K., Osmon, D. R., Mandrekar, J. N., Cockerill, F. R., Steckelberg, J. M., Greenleaf, J. F., Patel, R. (2007). Sonication of Removed Hip and Knee Prostheses for Diagnosis of Infection. NEJM 357: 654-663 [Abstract] [Full Text]  
  • Bori, G., Soriano, A., Garcia, S., Mallofre, C., Riba, J., Mensa, J. (2007). Usefulness of Histological Analysis for Predicting the Presence of Microorganisms at the Time of Reimplantation After Hip Resection Arthroplasty for the Treatment of Infection. JBJS 89: 1232-1237 [Abstract] [Full Text]  
  • Cui, Q., Mihalko, W. M., Shields, J. S., Ries, M., Saleh, K. J. (2007). Antibiotic-Impregnated Cement Spacers for the Treatment of Infection Associated with Total Hip or Knee Arthroplasty. JBJS 89: 871-882 [Full Text]  
  • Parvizi, J., Ghanem, E., Menashe, S., Barrack, R. L., Bauer, T. W. (2006). Periprosthetic Infection: What Are the Diagnostic Challenges?. JBJS 88: 138-147 [Full Text]  
  • Kotnis, R., Pasapula, C., Anwar, F., Cooke, P. H., Sharp, R. J. (2006). The management of failed ankle replacement. J Bone Joint Surg Br 88-B: 1039-1047 [Abstract] [Full Text]  
  • Phillips, J. E., Crane, T. P., Noy, M., Elliott, T. S. J., Grimer, R. J. (2006). The incidence of deep prosthetic infections in a specialist orthopaedic hospital: A 15-YEAR PROSPECTIVE SURVEY. J Bone Joint Surg Br 88-B: 943-948 [Abstract] [Full Text]  
  • Bauer, T. W., Parvizi, J., Kobayashi, N., Krebs, V. (2006). Diagnosis of Periprosthetic Infection. JBJS 88: 869-882 [Abstract] [Full Text]  
  • Toms, A. D., Davidson, D., Masri, B. A., Duncan, C. P. (2006). The management of peri-prosthetic infection in total joint arthroplasty. J Bone Joint Surg Br 88-B: 149-155 [Full Text]  
  • Little, C. P., Graham, A. J., Karatzas, G., Woods, D. A., Carr, A. J. (2005). Outcomes of Total Elbow Arthroplasty for Rheumatoid Arthritis: Comparative Study of Three Implants. JBJS 87: 2439-2448 [Abstract] [Full Text]  
  • Leone, J. M., Hanssen, A. D. (2005). Management of Infection at the Site of a Total Knee Arthroplasty. JBJS 87: 2335-2348 [Full Text]  
  • Sivadon, V., Rottman, M., Chaverot, S., Quincampoix, J.-C., Avettand, V., de Mazancourt, P., Bernard, L., Trieu-Cuot, P., Feron, J.-M., Lortat-Jacob, A., Piriou, P., Judet, T., Gaillard, J.-L. (2005). Use of Genotypic Identification by sodA Sequencing in a Prospective Study To Examine the Distribution of Coagulase-Negative Staphylococcus Species among Strains Recovered during Septic Orthopedic Surgery and Evaluate Their Significance. J. Clin. Microbiol. 43: 2952-2954 [Abstract] [Full Text]  
  • Zimmerli, W., Trampuz, A., Ochsner, P. E. (2004). Prosthetic-Joint Infections. NEJM 351: 1645-1654 [Full Text]  
  • Frank, K. L., Hanssen, A. D., Patel, R. (2004). icaA Is Not a Useful Diagnostic Marker for Prosthetic Joint Infection. J. Clin. Microbiol. 42: 4846-4849 [Abstract] [Full Text]  
  • (2001). Antimicrobial prophylaxis for orthopaedic surgery. DTB 39: 43-46 [Abstract] [Full Text]  
  • Giocoli, G. (2000). Evidence-Based Clinical Microbiology. J. Clin. Microbiol. 38: 3520-3521 [Full Text]  
  • Tunney, M. M., Patrick, S., Curran, M. D., Ramage, G., Hanna, D., Nixon, J. R., Gorman, S. P., Davis, R. I., Anderson, N. (1999). Detection of Prosthetic Hip Infection at Revision Arthroplasty by Immunofluorescence Microscopy and PCR Amplification of the Bacterial 16S rRNA Gene. J. Clin. Microbiol. 37: 3281-3290 [Abstract] [Full Text]  
  • Krimmer, V., Merkert, H., von Eiff, C., Frosch, M., Eulert, J., Löhr, J. F., Hacker, J., Ziebuhr, W. (1999). Detection of Staphylococcus aureus and Staphylococcus epidermidis in Clinical Samples by 16S rRNA-Directed In Situ Hybridization. J. Clin. Microbiol. 37: 2667-2673 [Abstract] [Full Text]  


Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»