Department of Infectious Diseases, Chonnam National University Hospital, Gwang-ju, Republic of Korea.
Department of Infectious Diseases, Chonnam National University Hospital Medical School, Gwang-ju, Republic of Korea.
PLoS One. 2024 Aug 15;19(8):e0309046. doi: 10.1371/journal.pone.0309046. eCollection 2024.
Although sonication is a valuable diagnostic tool for periprosthetic joint infections (PJI), it is not commonly utilized. We analyzed sonicate and intraoperative tissue culture results obtained from three hospitals to define the microbial etiology of PJIs in Korea. Furthermore, we investigated necessity of conducting regular fungal and mycobacterial cultures.
We retrospectively analyzed data for patients with suspected orthopedic-related infections between 2017 and 2022, who had undergone prostheses removal surgery. We included 193 patients with suspected PJIs, and bacterial (n = 193), fungal (n = 193), and mycobacterial (n = 186) cultures were conducted on both sonicate and intraoperative tissue samples. The diagnosis of PJI was based on the European Bone and Joint Infection Society (EBJIS) criteria.
Out of 193 patients, 121 (62.7%) had positive sonicate cultures, while 112 (58.0%) had positive periprosthetic tissue cultures. According to EBJIS criteria, a total of 181 patients were diagnosed with PJI, and 141 patients received microbiological confirmation through sonicate fluid culture or tissue culture. Of the 181 patients, 28 were classified with acute PJI (within 3 months of implantation) and 153 with chronic PJI. Among 141 patients, staphylococci were the most common organisms, accounting for 51.8% of cases, followed by Gram-negative organisms (15.6%), fungus (8.5%), and mycobacteria (3.5%). Nearly 91.7% of fungal isolates were Candida species, which also grew in bacterial cultures. In total, 11 cases cultured positive only in tissue culture, whereas 20 cases cultured positive only in sonicate culture. The antibiotic treatment plans were adjusted according to culture results.
Utilizing sonicate culture has greatly assisted in identifying pathogens responsible for chronic indolent PJIs, allowing suitable antimicrobial treatment. Based on few cases involving non-Candida and mycobacterial infections, it appears that routine fungal and mycobacterial cultures may not be necessary.
尽管超声检查是诊断假体周围关节感染（PJI）的一种有价值的诊断工具，但并未广泛应用。我们分析了来自 3 家医院的超声检查和术中组织培养结果，以确定韩国 PJI 的微生物病因。此外，我们还研究了进行常规真菌和分枝杆菌培养的必要性。
我们回顾性分析了 2017 年至 2022 年间接受假体取出手术的疑似骨科相关感染患者的数据。我们纳入了 193 例疑似 PJI 患者，对其超声检查和术中组织样本同时进行了细菌（n=193）、真菌（n=193）和分枝杆菌（n=186）培养。PJI 的诊断基于欧洲骨与关节感染学会（EBJIS）标准。
在 193 例患者中，121 例（62.7%）的超声检查培养阳性，112 例（58.0%）的假体周围组织培养阳性。根据 EBJIS 标准，共 181 例患者被诊断为 PJI，其中 141 例通过超声检查液培养或组织培养得到微生物学证实。在 181 例患者中，28 例为急性 PJI（植入后 3 个月内），153 例为慢性 PJI。在 141 例患者中，葡萄球菌是最常见的病原体，占 51.8%，其次是革兰氏阴性菌（15.6%）、真菌（8.5%）和分枝杆菌（3.5%）。近 91.7%的真菌分离株为念珠菌属，也在细菌培养中生长。共有 11 例仅在组织培养中培养阳性，20 例仅在超声检查培养中培养阳性。根据培养结果调整了抗生素治疗方案。
利用超声检查培养极大地帮助确定了导致慢性迁延性 PJI 的病原体，从而进行了适当的抗菌治疗。根据少数涉及非念珠菌和分枝杆菌感染的病例，似乎不需要常规进行真菌和分枝杆菌培养。
