Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 13;16(7):e0252322.
doi: 10.1371/journal.pone.0252322. eCollection 2021.

The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive

Taiana Cunha Ribeiro  1 , Emerson Kiyoshi Honda  2 , Daniel Daniachi  2 , Ricardo de Paula Leite Cury  2 , Cely Barreto da Silva  3 , Giselle Burlamaqui Klautau  1 , Mauro Jose Salles  1   4
Affiliations

The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive

Taiana Cunha Ribeiro et al. PLoS One. .

Abstract

Background: In the absence of a gold standard criterion for diagnosing prosthetic joint infections (PJI), sonication of the removed implant may provide superior microbiological identification to synovial fluid and peri-implant tissue cultures. The aim of this retrospective study was to assess the role of sonication culture compared to tissue cultures for diagnosing PJI, using different consensus and international guidelines for PJI definition.

Methods: Data of 146 patients undergoing removal of hip or knee arthroplasties between 2010 and 2018 were retrospectively reviewed. The International Consensus Meeting (ICM-2018), Musculoskeletal Infection Society (MSIS), Infectious Diseases Society of America (IDSA), the European Bone and Joint Infection Society (EBJIS), and a modified clinical criterion, were used to compare the performance of microbiological tests. McNemar´s test and proportion comparison were employed to calculate p-value.

Results: Overall, 56% (82/146) were diagnosed with PJI using the clinical criteria. Out of these cases, 57% (47/82) tested positive on tissue culture and 93% (76/82) on sonication culture. Applying this clinical criterion, the sensitivity of sonication fluid and tissue cultures was 92.7% (95% CI: 87.1%- 98.3%) and 57.3% (95% CI: 46.6%-68.0%) (p<0.001), respectively. When both methods were combined for diagnosis (sonication and tissue cultures) sensitivity reached 96.3% (95% CI: 91.5%-100%). Sonication culture and the combination of sonication with tissue cultures, showed higher sensitivity rates than tissue cultures alone for all diagnostic criteria (ICM-18, MSIS, IDSA and EBJIS) applied. Conversely, tissue culture provided greater specificity than sonication culture for all the criteria assessed, except for the EBJIS criteria, in which sonication and tissue cultures specificity was 100% and 95.3% (95% CI: 87.8-100%), respectively (p = 0.024).

Conclusions: In a context where diagnostic criteria available have shortcomings and tissue cultures remain the gold standard, sonication cultures can aid PJI diagnosis, especially when diagnostic criteria are inconclusive due to some important missing data (joint puncture, histology).

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Sensitivity of sonication (S), tissue cultures (T) and tissue plus sonication (TS) for the following diagnostic criteria and according to number of tissue samples collected.
Diagnostic criteria: clinical modified (A), IDSA (B), ICM (C) and EBJIS (D). Number of tissue samples collected: 1: 2–4 tissue samples; 2: 5–7 tissue samples; 3: ≥8 tissue samples. PJI: prosthetic joint infection; ICM: International Consensus Meeting; IDSA: Infectious Diseases Society of America; EBJIS: European Bone and Joint Infection Society.
See this image and copyright information in PMC

References

    1. Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, et al.. Diagnosis and management of prosthetic joint infection: Clinical practice guidelines by the infectious diseases Society of America. Clin Infect Dis. 2013;56(1):1–25. doi: 10.1093/cid/cis966 - DOI - PubMed
    1. Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, et al.. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty [Internet]. 2018;33(5):1309–1314.e2. doi: 10.1016/j.arth.2018.02.078 - DOI - PubMed
    1. Parvizi J, Gehrke T. Definition of periprosthetic joint infection. J Arthroplasty. 2014;29(7):1331. doi: 10.1016/j.arth.2014.03.009 - DOI - PubMed
    1. McNally M, Sousa R, Wouthuyzen-Bakker M, Chen AF, Soriano A, Vogely HC, et al.. The EBJIS definition of periprosthetic joint infection. Bone Joint J. 2021;103-B(1):18–25. doi: 10.1302/0301-620X.103B1.BJJ-2020-1381.R1 - DOI - PMC - PubMed
    1. Ochsner P., Borens O., Bodler P., Broger I., Maurer T. and HN. Infections of the musculoskeletal system. Basic principles, prevention, diagnosis and treatment. Swiss Orthop Swiss Soc Infect Dis Expert Gr. 2014.