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Journal of Clinical Microbiology, October 1999, p. 3281-3290, Vol. 37, No. 10
Department of Microbiology and Immunobiology,
Received 19 January 1999/Returned for modification 2 May
1999/Accepted 26 June 1999
In this study the detection rates of bacterial infection of hip
prostheses by culture and nonculture methods were compared for 120 patients with total hip revision surgery. By use of strict anaerobic
bacteriological practice during the processing of samples and without
enrichment, the incidence of infection by culture of material dislodged
from retrieved prostheses after ultrasonication (sonicate) was 22%.
Bacteria were observed by immunofluorescence microscopy in 63% of
sonicate samples with a monoclonal antibody specific for
Propionibacterium acnes and polyclonal antiserum specific
for Staphylococcus spp. The bacteria were present either as
single cells or in aggregates of up to 300 bacterial cells. These
aggregates were not observed without sonication to dislodge the
biofilm. Bacteria were observed in all of the culture-positive samples,
and in some cases in which only one type of bacterium was identified by
culture, both coccoid and coryneform bacteria were observed by
immunofluorescence microscopy. Bacteria from skin-flake contamination
were readily distinguishable from infecting bacteria by
immunofluorescence microscopy. Examination of skin scrapings did not
reveal large aggregates of bacteria but did reveal skin cells. These
were not observed in the sonicates. Bacterial DNA was detected in 72%
of sonicate samples by PCR amplification of a region of the bacterial
16S rRNA gene with universal primers. All of the culture-positive
samples were also positive for bacterial DNA. Evidence of high-level
infiltration either of neutrophils or of lymphocytes or macrophages
into associated tissue was observed in 73% of patients. Our results
indicate that the incidence of prosthetic joint infection is grossly
underestimated by current culture detection methods. It is therefore
imperative that current clinical practice with regard to the detection
and subsequent treatment of prosthetic joint infection be reassessed in
the light of these results.
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
Detection of Prosthetic Hip Infection at Revision
Arthroplasty by Immunofluorescence Microscopy and PCR Amplification of
the Bacterial 16S rRNA Gene
*
Corresponding author. Mailing address: Department of
Microbiology and Immunobiology, School of Clinical Medicine, The
Queen's University of Belfast, Grosvenor Rd., Belfast BT12 6BN, United Kingdom. Phone: 01232-263205. Fax: 01232-439181. E-mail:
s.patrick{at}qub.ac.uk.
Journal of Clinical Microbiology, October 1999, p. 3281-3290, Vol. 37, No. 10
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.
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