Kolenda Camille, Josse Jérôme, Batailler Cécile, Faure Allison, Monteix Alice, Lustig Sébastien, Ferry Tristan, Laurent Frédéric, Dupieux Céline
CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS UMR5308, ENS de Lyon, Lyon, France.
Centre de Référence des Infections Ostéo-Articulaires Complexes de Lyon, Lyon, France.
Front Med (Lausanne). 2021 Mar 16;8:565555. doi: 10.3389/fmed.2021.565555. eCollection 2021.
In prosthetic joint infections (PJIs), identification of the causative microorganisms is critical to successfully adapt and optimize treatment. However, microbiological diagnosis of PJIs remains a challenge notably because bacteria are embedded in biofilm adhered to the prosthetic material. Recently, dithiothreitol (DTT) treatment of prosthesis has been proposed as a new strategy to release bacteria from biofilm and to improve the yield of microbiological diagnosis. In this study, we evaluated the interest of a commercial device using DTT, the MicroDTTect system (Heraeus, Hanau, Germany), for the diagnosis of low-grade chronic PJIs, compared to the conventional culture of periprosthetic tissue (PPT) samples. Twenty patients undergoing a surgery procedure for removal of prosthetic material because of a suspicion of low-grade PJI without pre-operative microbiological documentation were included (NCT04371068). Bacteriological results using the fluid obtained after prosthesis treatment with the MicroDTTect system were compared to results obtained with conventional culture of PPT samples. All the bacteria considered as responsible for PJIs recovered from culture of PPT samples were also detected using the MicroDTTect device. For one patient, an additional bacterial isolate () suspected to be involved in a polymicrobial PJI was identified using DTT treatment. Time to positivity of the cultures was also reduced using the MicroDTTect system, notably in case of infection. However, probable bacterial contaminants were found (MicroDTTect system, = 5; PPT samples, = 1). This study showed that DTT treatment of the prosthetic component using the MicroDTTect device could improve the microbiological diagnosis of low-grade PJIs.
在人工关节感染（PJI）中，鉴定致病微生物对于成功调整和优化治疗至关重要。然而，PJI的微生物学诊断仍然是一项挑战，特别是因为细菌嵌入附着在假体材料上的生物膜中。最近，有人提出用二硫苏糖醇（DTT）处理假体作为一种从生物膜中释放细菌并提高微生物学诊断阳性率的新策略。在本研究中，我们评估了一种使用DTT的商业设备——MicroDTTect系统（德国哈瑙贺利氏公司）在诊断低度慢性PJI方面的价值，并与假体周围组织（PPT）样本的传统培养方法进行了比较。纳入了20例因怀疑低度PJI而接受假体材料移除手术且术前无微生物学记录的患者（NCT04371068）。将使用MicroDTTect系统处理假体后获得的液体的细菌学结果与PPT样本传统培养获得的结果进行比较。从PPT样本培养中分离出的所有被认为是PJI致病菌的细菌，使用MicroDTTect设备也能检测到。对于一名患者，使用DTT处理鉴定出一种额外的疑似参与多微生物PJI的细菌分离株。使用MicroDTTect系统还缩短了培养的阳性时间，特别是在感染的情况下。然而，发现了可能的细菌污染物（MicroDTTect系统，=5；PPT样本，=1）。这项研究表明，使用MicroDTTect设备对假体部件进行DTT处理可以改善低度PJI的微生物学诊断。
