Use of blood culture vial specimens in intraoperative detection of infection.

A retrospective study was performed evaluating the results of three different intraoperative culture techniques and their diagnostic value in determining clinical infection in patients after a total joint replacement. Twenty-four patients (34 cases) met the selection criteria and were evaluated using intraoperatively collected tissue samples, swab samples, and fluid samples injected into standard blood culture vials. Results of the cultures of these specimens were compared with the clinical diagnoses to determine specificity, sensitivity, and accuracy of each technique. The current study suggests the use of fluid aspirate from intraoperative wounds immediately injected into blood culture vials is a highly specific, sensitive, and accurate diagnostic culture technique (100%, 92%, and 94%, respectively). The superiority of vial cultures is enhanced when organisms grown from the liquid media only are discounted as contaminants. This led to significant decreases in the sensitivity and accuracy of swab culture and tissue biopsy results when compared with vial culture results. Thus, vial cultures are a more cost-effective means for intraoperative detection of infection.