TABLE 2

Additional pathogens identified in sonicate fluid by the BCID panel and not detected by sonicate fluid culture

Additional pathogen detected by BCIDConventional culture results for pathogen detected by BCIDPathogen(s) coisolated by cultureRecent antimicrobial therapyCorroborative molecular testing result(s)
mecA-negative SCNSonicate cultures with <20 CFU/10 ml SCNNoneFusidic acid until surgeryPCR/ESI-MS, S. caprae/epidermidis; 16S rRNA gene PCR, Staphylococcus sp.; 10-assay PCR panel, SCN
mecA-negative S. aureusNoneaMethicillin-resistant SCNOxacillin until surgery16S rRNA gene PCR + 10-assay PCR panel, S. aureus
Streptococcus agalactiae (GBS)Sonicate cultures with <20 CFU/10 ml GBSbNonePenicillin G/ceftriaxone until surgery16S rRNA gene PCR + 10-assay PCR panel, GBS
Klebsiella pneumoniaeSonicate cultures with <20 CFU/10 ml K. pneumoniaecNoneTrimethoprim-sulfamethoxazole–rifampin until 7 days before surgery10-assay PCR panel, Enterobacteriaceae
Enterobacter cloacaeNoneMRSA,e Finegoldia magna, Corynebacterium speciesTrimethoprim-sulfamethoxazole until 7 days before surgery10-assay PCR panel, Enterobacteriaceae
Candida albicansNonedMethicillin-resistant S. epidermidisTrimethoprim-sulfamethoxazole–levofloxacin until 3 days before surgeryNone
  • a Cultures from external institution with methicillin-sensitive S. aureus previously.

  • b Preoperative aspirate with GBS (group B Streptococcus species).

  • c One of five tissue cultures with K. pneumoniae.

  • d None detected in corresponding sonicate cultures; however, C. albicans was detected in operative cultures obtained 1 month later when the cement spacer was replaced.

  • e MRSA, methicillin-resistant S. aureus.