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Bacteriology

Sonication Culture of Antimicrobial Agent-Containing Cement Spacers Removed during Staged Revisions for Arthroplasty Infection

Eric Gomez-Urena, Rafael J. Sierra, Kerryl E. Greenwood-Quiantance, Melissa J. Karau, James M. Steckelberg, Robin Patel
Sandra S. Richter, Editor
Eric Gomez-Urena
Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Rafael J. Sierra
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Kerryl E. Greenwood-Quiantance
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Melissa J. Karau
Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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James M. Steckelberg
Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Robin Patel
Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USADivision of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Sandra S. Richter
Cleveland Clinic
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DOI: 10.1128/JCM.01483-18
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ABSTRACT

Diagnosis of persistent infection at the time of reimplantation for staged revision of infected arthroplasties is challenging. Implant sonication culture for the diagnosis of prosthetic joint infection (PJI) has improved sensitivity compared to standard periprosthetic tissue culture. We report our experience with periprosthetic tissue culture and sonication culture of antimicrobial agent-containing cement spacers (ACSs) collected during second stages of staged revisions for arthroplasty infection. We studied 87 ACSs from 66 patients undergoing two-stage revision arthroplasty for PJI submitted for sonication culture, along with conventional periprosthetic tissue cultures. Two or more positive periprosthetic tissue cultures with the same organism were considered a positive tissue culture. For sonication culture, ≥20 CFU of bacteria per 10 ml of sonicate fluid was considered positive. The sensitivity and specificity of periprosthetic tissue and ACS sonication culture in detecting persistent infection, as well as their association with outcome, were assessed. Persistent infection occurred in 26% of cases. Periprosthetic tissue and sonicate fluid culture had specificities of 96.3 and 100% (P = 0.50), respectively, and sensitivities of 31.6 and 26.3% (P = 1.00), respectively, for the diagnosis of persistent infection. Thirteen subjects deemed not to have persistent infection at time of reimplantation and who had negative periprosthetic tissue and sonicate fluid cultures subsequently developed overt infection. Sonication culture of cement spacers identifies a similar proportion of patients with persistent infection during staged revisions, as detected by periprosthetic tissue cultures; both have low sensitivities to detect persistent infection.

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Sonication Culture of Antimicrobial Agent-Containing Cement Spacers Removed during Staged Revisions for Arthroplasty Infection
Eric Gomez-Urena, Rafael J. Sierra, Kerryl E. Greenwood-Quiantance, Melissa J. Karau, James M. Steckelberg, Robin Patel
Journal of Clinical Microbiology Jan 2019, 57 (2) e01483-18; DOI: 10.1128/JCM.01483-18

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Sonication Culture of Antimicrobial Agent-Containing Cement Spacers Removed during Staged Revisions for Arthroplasty Infection
Eric Gomez-Urena, Rafael J. Sierra, Kerryl E. Greenwood-Quiantance, Melissa J. Karau, James M. Steckelberg, Robin Patel
Journal of Clinical Microbiology Jan 2019, 57 (2) e01483-18; DOI: 10.1128/JCM.01483-18
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KEYWORDS

antibiotic cement
prosthetic joint infection
sonication

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