Blood Culture Flasks for Culturing Synovial Fluid in Prosthetic Joint Infections

Background Identifying the etiologic microorganism is essential to guide antimicrobial therapy in prosthetic joint infection. Questions/purpose We (1) compared the frequency of positive cultures with synovial fluid inoculated in blood culture flasks (SF) with those of periprosthetic tissues or swabs...

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Bibliographic Details
Published in:Clinical orthopaedics and related research 2010-08, Vol.468 (8), p.2238-2243
Main Authors: Font-Vizcarra, Lluís, García, Sebastián, Martínez-Pastor, Juan C., Sierra, Josep M., Soriano, Alex
Format: Article
Language:English
Subjects:
Aged
Arthroplasty, Replacement - adverse effects
Arthroplasty, Replacement - instrumentation
Bacterial Infections - blood
Bacterial Infections - diagnosis
Bacterial Infections - microbiology
Bacteriological Techniques - methods
Biological and medical sciences
Blood Specimen Collection
Clinical Research
Conservative Orthopedics
Culture Media
Diseases of the osteoarticular system
Female
Hip Joint - microbiology
Hip Joint - pathology
Hip Joint - surgery
Humans
Infection
Joint Prosthesis - adverse effects
Joint Prosthesis - microbiology
Knee Joint - microbiology
Knee Joint - pathology
Knee Joint - surgery
Male
Medical sciences
Medicine
Medicine & Public Health
Microbial Sensitivity Tests
Orthopedics
Predictive Value of Tests
Prosthesis-Related Infections - blood
Prosthesis-Related Infections - diagnosis
Prosthesis-Related Infections - microbiology
Retrospective Studies
Sports Medicine
Surgery
Surgical Orthopedics
Surgical Wound Infection - blood
Surgical Wound Infection - diagnosis
Surgical Wound Infection - microbiology
Synovial Fluid - microbiology
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Summary:Background Identifying the etiologic microorganism is essential to guide antimicrobial therapy in prosthetic joint infection. Questions/purpose We (1) compared the frequency of positive cultures with synovial fluid inoculated in blood culture flasks (SF) with those of periprosthetic tissues or swabs in traditional cultures from patients with acute and chronic prosthetic joint infections (PJI) and (2) determined the sensitivity, specificity, and predictive values of the three methods. Patients and Methods We retrospectively reviewed 87 patients with PJIs (54 knees, 33 hips) and 63 patients with aseptic loosening (34 knees, 29 hips). Two SF, periprosthetic tissue, and swab samples were taken for culture in all 150 patients except for 14 in whom only one SF fluid sample was obtained. Synovial fluid was inoculated in blood culture flasks and periprosthetic tissue and swab samples in standard media. Positive cultures were identified with standard biochemical procedures. Results SF samples were positive in 78 of 87 infected cases (90%), periprosthetic tissue samples were positive in 71 (82%), and swab samples were positive in 59 (68%). SF, periprosthetic tissue, and swab samples were positive more frequently in acute than in chronic infections (96% versus 82% for SF, 87% versus 74% for periprosthetic tissue, and 87% versus 44% for swabs). The sensitivity, specificity, and positive and negative predictive values of SF were 91, 100, 100, and 93 for acute infections and 79, 100, 100, and 88 for chronic infections, respectively. Conclusions SF samples cultured in flasks had higher sensitivity, specificity, and positive and negative predictive values for diagnosis of PJI when compared with standard tissue and swab samples. The usefulness of all samples was less in chronic than in acute infections. Level of Evidence Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
ISSN:0009-921X
1528-1132
DOI:10.1007/s11999-010-1254-3