在日常临床环境中对骨科植入物进行超声处理的价值——一项探索性研究。
The value of sonication on orthopaedic implants in an everyday clinical setting - an exploratory study.
机构信息
Department of Clinical Medicine, Aarhus University, Aarhus, 8000, Denmark.
Department of Orthopaedic Surgery, Aarhus University Hospital 8200, Aarhus, Denmark.
出版信息
BMC Musculoskelet Disord. 2023 Aug 29;24(1):691. doi: 10.1186/s12891-023-06796-x.
BACKGROUND
Sonication of removed orthopaedic implants in suspected implant-associated infections (IAI) is widely applied internationally. However, evaluation of the utility of sonication on all implants removed in everyday standard practice is scarce. This exploratory study was performed to evaluate the application of sonication fluid (SF) culture on removed orthopaedic implants, irrespective of the reason for removal.
METHODS
Out of 100 removed orthopaedic implants collected between August 2019 and September 2020, 77 implants with availability of concurrent tissue culture samples were included in the study. Removed implants were categorized into a confirmed or suspected IAI group and a presumed aseptic group based on pre-operative diagnosis by the responsible surgeon. Implants were sonicated and SF culture performed under both aerobic and anaerobic conditions. The significance of all bacterial isolates was evaluated based on the CFU/mL cut-offs of the EBJIS guidelines, except for C. acnes where additional investigations were performed.
RESULTS
The results of SF culture in the two groups were compared with their corresponding tissue cultures. Out of the 12 cases in the confirmed/suspected IAI group, SF culture was positive in 11 cases and had increased diagnostic yield in two (17%) cases compared to tissue culture. Increased diagnostic yield of SF compared to tissue culture was seen in seven (11%) of the 65 implants in the presumed aseptic group. If growth of Cutibacterium species isolates were interpreted based on EBJIS cut-off for SF culture instead of the study-specific criteria, then two isolates considered to represent infection might have been missed while three other isolates considered contaminants would have fallen under the 'infection confirmed' category in the EBJIS guidelines.
CONCLUSION
Sonication with SF culture has increased diagnostic yield compared to tissue cultures in all implants irrespective of reason for removal. However, positive SF cultures with Cutibacterium species should always be interpreted with extreme care.
背景
在疑似植入物相关感染（IAI）中，对取出的骨科植入物进行超声处理在国际上得到广泛应用。然而，在日常标准实践中，对所有取出的植入物进行超声处理的效用评估却很少。本探索性研究旨在评估无论取出原因如何，对取出的骨科植入物进行超声处理液（SF）培养的应用。
方法
在 2019 年 8 月至 2020 年 9 月期间收集的 100 个取出的骨科植入物中，77 个有同时获得组织培养样本的植入物被纳入研究。根据负责外科医生的术前诊断，将取出的植入物分为确诊/疑似 IAI 组和假定无菌组。在有氧和无氧条件下对植入物进行超声处理并进行 SF 培养。所有细菌分离株的意义均根据 EBJIS 指南的 CFU/mL 截断值进行评估，除了痤疮丙酸杆菌，需要进行额外的研究。
结果
比较了两组 SF 培养物的结果及其相应的组织培养物。在确诊/疑似 IAI 组的 12 例中，SF 培养物阳性 11 例，与组织培养物相比，SF 培养物的诊断产量增加了 2 例（17%）。在假定无菌组的 65 个植入物中，SF 培养物与组织培养物相比，诊断产量增加了 7 例（11%）。如果根据 EBJIS 对 SF 培养物的截断值而不是研究特定的标准来解释 Cutibacterium 种分离株的生长情况，那么两个被认为代表感染的分离株可能会被漏掉，而另外三个被认为是污染物的分离株则会根据 EBJIS 指南落入“感染确诊”类别。
结论
无论取出原因如何，SF 培养物的超声处理与组织培养物相比，均提高了诊断产量。然而，对于含有痤疮丙酸杆菌的 SF 阳性培养物，应格外小心解释。
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