Oliva Alessandra, Mascellino Maria Teresa, Nguyen Bich Lien, De Angelis Massimiliano, Cipolla Alessia, Di Berardino Annalisa, Ciccaglioni Antonio, Mastroianni Claudio Maria, Vullo Vincenzo
Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
Electrophysiology Section, Cardiology Department, Sapienza University, Rome, Italy.
J Glob Infect Dis. 2018 Apr-Jun;10(2):74-79. doi: 10.4103/jgid.jgid_31_17.
Sonication showed more sensitivity than traditional culture in the diagnosis of device infections. Aims of the study were to assess the role of sonication in the microbiological diagnosis and management of cardiac device infections (CDIs), to evaluate the sensitivity of sonication in patients on antimicrobial therapy at the time of device removal, and to analyze biofilm formation of the isolated strains.
A total of 90 devices (31 generators and 59 electrodes) collected from 31 patients with infection underwent sonication before culture. Devices were sonicated for 5 min and centrifuged at 3200 rpm for 15 min. Intraoperative traditional cultures were performed in 26 patients. Microorganisms were identified using conventional methods. Staphylococcal strains were tested for slime production.
Microbiological diagnosis was achieved in 28 patients (90%). Sonicate fluid was positive in 68/90 (76%) of devices (27/31 [87%] generators and 41/59 [69%] electrodes), whereas intraoperative pocket swabs grew bacteria in 10/26 patients (38%, = 0.0007). Among leads, 37/59 (62.7%) yielded bacteria even in the absence of vegetation. Coagulase-negative Staphylococci accounted for 83.8% (57/68) of the total; and Gram-negative bacilli were found in 4.4% (3/68) and 5.8% (4/68), respectively. Biofilm production was present in 15/22 (69%) staphylococcal strains. Overall, patients on therapy ( = 23) had a microbiological diagnosis in 20/23 (86.9%) and 7/22 (30.4%) through sonication and intraoperative cultures, respectively ( = 0.0002).
Our data showed the high sensitivity of sonication in the diagnosis of CDIs, even in patients under antimicrobial therapy.
Sonication represents an essential tool for both diagnosis and management of CDIs.
在装置感染的诊断中，超声处理显示出比传统培养方法更高的敏感性。本研究的目的是评估超声处理在心脏装置感染（CDI）的微生物学诊断和管理中的作用，评估在移除装置时接受抗菌治疗的患者中超声处理的敏感性，并分析分离菌株的生物膜形成情况。
从31例感染患者中收集了90个装置（31个发生器和59个电极），在培养前进行超声处理。将装置超声处理5分钟，然后以3200转/分钟的速度离心15分钟。26例患者进行了术中传统培养。使用常规方法鉴定微生物。对葡萄球菌菌株进行黏液产生检测。
28例患者（90%）实现了微生物学诊断。在90个装置中的68个（76%）（27个/31个[87%]发生器和41个/59个[69%]电极）中，超声处理液呈阳性，而术中囊袋拭子在10/26例患者中培养出细菌（38%，P = 0.0007）。在导联中，即使没有赘生物，59个中的37个（62.7%）也培养出细菌。凝固酶阴性葡萄球菌占总数的83.8%（57/68）；革兰氏阴性杆菌分别占4.4%（3/68）和5.8%（4/68）。22株葡萄球菌菌株中有15株（69%）产生生物膜。总体而言，接受治疗的患者（n = 23）通过超声处理和术中培养分别在20/23（86.9%）和7/22（30.4%）中实现了微生物学诊断（P = 0.0002）。
我们的数据显示，即使在接受抗菌治疗的患者中，超声处理在CDI诊断中也具有高敏感性。
超声处理是CDI诊断和管理的重要工具。
