Kickinger Bernhardt, Monsen Tor, Karis Emma, Widerström Micael, Sundin Petter, Nilsson Kjell G, Otten Volker, Crnalic Sead
Department of Diagnostics and Intervention, Umeå University, Sweden.
Department of Clinical Microbiology, Umeå University, Sweden.
Acta Orthop. 2025 Jun 9;96:429-436. doi: 10.2340/17453674.2025.43679.
Sonication fluid cultures have been proposed as a complementary diagnostic method to intraoperative tissue culture sampling for the diagnosis of periprosthetic joint infection (PJI). We evaluated whether sonication provides additional clinically relevant information in the diagnosis of PJI in hip revision.
Episodes of hip revision performed between January 2007 and December 2016 were assigned retrospectively to the European Bone and Joint Infection Society (EBJIS) definition of periprosthetic joint infection: infection unlikely, infection likely, and infection confirmed. The inclusion criteria were a minimum of 2 perioperative tissue cultures collected at the index procedure and sonication performed on a removed implant. The results of the tissue cultures were compared with the results of the implant sonication fluid cultures (SFCs).
288 hip revision episodes in 250 patients fulfilled the inclusion criteria and were analyzed. The "infection unlikely" group included 203 episodes (178 patients), the "infection likely" group included 5 episodes (5 patients), and the "infection confirmed" group included 80 episodes (67 patients). SFC delivered additional clinical information in 15/288: 6 of 203 episodes in the "infection unlikely" group, 2 of 5 episodes in the "infection likely" group, and 7 of 80 in the "infection confirmed" group. Coagulase-negative staphylococci and Staphylococcus aureus were the dominant bacterial species in both the SFC and tissue cultures.
In addition to tissue cultures, sonication fluid cultures optimized the microbiological yield in 15 out of 288 hip revision episodes.
超声处理液体培养已被提议作为术中组织培养采样的一种补充诊断方法，用于诊断人工关节周围感染（PJI）。我们评估了超声处理在髋关节翻修术中PJI诊断中是否能提供额外的临床相关信息。
回顾性分析2007年1月至2016年12月期间进行的髋关节翻修病例，根据欧洲骨与关节感染学会（EBJIS）对人工关节周围感染的定义进行分类：感染可能性不大、感染可能性较大和感染确诊。纳入标准为在初次手术时至少采集2份围手术期组织培养样本，并对取出的植入物进行超声处理。将组织培养结果与植入物超声处理液体培养（SFC）结果进行比较。
250例患者的288例髋关节翻修病例符合纳入标准并进行了分析。“感染可能性不大”组包括203例（178例患者），“感染可能性较大”组包括5例（5例患者），“感染确诊”组包括80例（67例患者）。SFC在288例中有15例提供了额外的临床信息：“感染可能性不大”组的203例中有6例，“感染可能性较大”组的5例中有2例，“感染确诊”组的80例中有7例。凝固酶阴性葡萄球菌和金黄色葡萄球菌是SFC和组织培养中的主要细菌种类。
除组织培养外，超声处理液体培养在288例髋关节翻修病例中的15例优化了微生物学检测结果。
