Sonication in the diagnosis of fracture-related infections (FRI)—a retrospective study on 230 retrieved implants
Abstract Background In fracture-related infections (FRI), both the diagnosis of the infection and the identification of the causative pathogen are crucial to optimize treatment outcomes. Sonication has been successfully used for periprosthetic joint infections (PJI); however, its role in FRI remains...
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| Format: | Article |
| Language: | English |
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BMC
2021-05-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-021-02460-z |
| _version_ | 1811279334184321024 |
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| author | Petri Bellova Veronika Knop-Hammad Matthias Königshausen Thomas A. Schildhauer Jan Gessmann Hinnerk Baecker |
| author_facet | Petri Bellova Veronika Knop-Hammad Matthias Königshausen Thomas A. Schildhauer Jan Gessmann Hinnerk Baecker |
| author_sort | Petri Bellova |
| collection | DOAJ |
| description | Abstract Background In fracture-related infections (FRI), both the diagnosis of the infection and the identification of the causative pathogen are crucial to optimize treatment outcomes. Sonication has been successfully used for periprosthetic joint infections (PJI); however, its role in FRI remains unknown. Our aim was to determine the diagnostic accuracy (sensitivity, specificity) of sonicate fluid culture (SFC). The primary objective was to compare SFC with peri-implant tissue culture (PTC) overall and among subgroups using the consensus definition by Metsemakers et al. The secondary objective was to determine the yield of SFC in possible fracture-related infections (PFRI). Methods From March 2017 to May 2019, 230 cases of retrieved implants were retrospectively reviewed. To perform sonication, explants were placed in sterile polypropylene jars intraoperatively. After treatment in an ultrasonic bath (Bandelin, Berlin, Germany), sonicate fluid was incubated into blood culture bottles, and conventional culturing was eventually performed. Sensitivity and specificity were determined using two-by-two contingency tables. McNemar’s test was used to compare proportions among paired samples while Fisher’s exact test was used for comparison between categorical variables. Results Of the 230 cases, 107 were identified as FRI, whereas 123 were aseptic revision cases (ARC). Of the latter, 105 were labeled as PFRI. Sensitivity of SFC was higher in comparison with PTC, although this did not reach statistical significance (90.7% vs. 84.1%; p = .065). The specificity of SFC was significantly lower than that of PTC (73.2% vs. 88.6%; p = .003). In PFRI, SFC yielded significantly more positive results than PTC (33/105 vs. 14/105; p = .003). Overall, 142 pathogens were identified by SFC, whereas 131 pathogens were found by PTC. Conclusions We found that sonication of fracture fixation devices may be a useful adjunct in FRI, especially in “low-grade” infections lacking confirmatory clinical criteria. Standardized diagnostic protocols are warranted in order to further optimize the diagnostic accuracy. |
| first_indexed | 2024-04-13T00:52:45Z |
| format | Article |
| id | doaj.art-02b14490bfcc49ccbc67f374214c1665 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-13T00:52:45Z |
| publishDate | 2021-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-02b14490bfcc49ccbc67f374214c16652022-12-22T03:09:48ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2021-05-011611910.1186/s13018-021-02460-zSonication in the diagnosis of fracture-related infections (FRI)—a retrospective study on 230 retrieved implantsPetri Bellova0Veronika Knop-Hammad1Matthias Königshausen2Thomas A. Schildhauer3Jan Gessmann4Hinnerk Baecker5Department of Orthopedics and Trauma Surgery, BG University Clinic Bergmannsheil BochumDepartment of Microbiology, BG University Clinic Bergmannsheil BochumDepartment of Orthopedics and Trauma Surgery, BG University Clinic Bergmannsheil BochumDepartment of Orthopedics and Trauma Surgery, BG University Clinic Bergmannsheil BochumDepartment of Orthopedics and Trauma Surgery, BG University Clinic Bergmannsheil BochumDepartment of Orthopedics and Trauma Surgery, BG University Clinic Bergmannsheil BochumAbstract Background In fracture-related infections (FRI), both the diagnosis of the infection and the identification of the causative pathogen are crucial to optimize treatment outcomes. Sonication has been successfully used for periprosthetic joint infections (PJI); however, its role in FRI remains unknown. Our aim was to determine the diagnostic accuracy (sensitivity, specificity) of sonicate fluid culture (SFC). The primary objective was to compare SFC with peri-implant tissue culture (PTC) overall and among subgroups using the consensus definition by Metsemakers et al. The secondary objective was to determine the yield of SFC in possible fracture-related infections (PFRI). Methods From March 2017 to May 2019, 230 cases of retrieved implants were retrospectively reviewed. To perform sonication, explants were placed in sterile polypropylene jars intraoperatively. After treatment in an ultrasonic bath (Bandelin, Berlin, Germany), sonicate fluid was incubated into blood culture bottles, and conventional culturing was eventually performed. Sensitivity and specificity were determined using two-by-two contingency tables. McNemar’s test was used to compare proportions among paired samples while Fisher’s exact test was used for comparison between categorical variables. Results Of the 230 cases, 107 were identified as FRI, whereas 123 were aseptic revision cases (ARC). Of the latter, 105 were labeled as PFRI. Sensitivity of SFC was higher in comparison with PTC, although this did not reach statistical significance (90.7% vs. 84.1%; p = .065). The specificity of SFC was significantly lower than that of PTC (73.2% vs. 88.6%; p = .003). In PFRI, SFC yielded significantly more positive results than PTC (33/105 vs. 14/105; p = .003). Overall, 142 pathogens were identified by SFC, whereas 131 pathogens were found by PTC. Conclusions We found that sonication of fracture fixation devices may be a useful adjunct in FRI, especially in “low-grade” infections lacking confirmatory clinical criteria. Standardized diagnostic protocols are warranted in order to further optimize the diagnostic accuracy.https://doi.org/10.1186/s13018-021-02460-zSonicationFracture-related infectionBiofilmSensitivitySpecificity |
| spellingShingle | Petri Bellova Veronika Knop-Hammad Matthias Königshausen Thomas A. Schildhauer Jan Gessmann Hinnerk Baecker Sonication in the diagnosis of fracture-related infections (FRI)—a retrospective study on 230 retrieved implants Journal of Orthopaedic Surgery and Research Sonication Fracture-related infection Biofilm Sensitivity Specificity |
| title | Sonication in the diagnosis of fracture-related infections (FRI)—a retrospective study on 230 retrieved implants |
| title_full | Sonication in the diagnosis of fracture-related infections (FRI)—a retrospective study on 230 retrieved implants |
| title_fullStr | Sonication in the diagnosis of fracture-related infections (FRI)—a retrospective study on 230 retrieved implants |
| title_full_unstemmed | Sonication in the diagnosis of fracture-related infections (FRI)—a retrospective study on 230 retrieved implants |
| title_short | Sonication in the diagnosis of fracture-related infections (FRI)—a retrospective study on 230 retrieved implants |
| title_sort | sonication in the diagnosis of fracture related infections fri a retrospective study on 230 retrieved implants |
| topic | Sonication Fracture-related infection Biofilm Sensitivity Specificity |
| url | https://doi.org/10.1186/s13018-021-02460-z |
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