Improved Diagnosis of Infection Associated with Osteosynthesis by Use of Sonication of Fracture Fixation Implants

Author(s)

Yano, Maysa Harumi ^[1] ; Klautau, Giselle Burlamaqui ^[2] ; da Silva, Cely Barreto ^[3] ; Nigro, Stanley ^[3] ; Avanzi, Osmar ^[4] ; Mercadante, Marcelo Tomanink ^[4] ; Costa Salles, Mauro Jose ^[2]

Affiliation

^[1] Santa Isabel Hosp, Infect Control Unit, Sao Paulo - Brazil

^[2] Santa Casa de Sao Paulo Sch Med, Dept Internal Med, Div Infect Dis, Sao Paulo - Brazil

^[3] Santa Casa de Sao Paulo Sch Med, Dept Lab Med & Pathol, Sao Paulo - Brazil

^[4] Santa Casa de Sao Paulo Sch Med, Dept Orthoped Surg, Sao Paulo - Brazil

• Document type: Journal article
• Source: Journal of Clinical Microbiology; v. 52, n. 12, p. 4176-4182, DEC 2014.
• Web of Science Citations: 27

Abstract

Previous studies have shown that sonication fluid cultures from removed orthopedic devices improved the microbiological diagnosis of orthopedic implant-associated infections; however, few of these investigations have applied sonication to the removed fracture fixation devices to evaluate its utility for the diagnosis of osteosynthesis-associated infection (OAI). We compared sonication fluid to conventional tissue cultures from 180 subjects with different sizes of plates and screws (n = 156), spinal implants (n = 26), and intramedullary nails (n = 3), of whom 125 and 55 subjects had OAI and noninfected osteosynthesis (NIO), respectively. The sensitivity for detecting OAI was 90.4% for sonication fluid culture and 56.8% for periprosthetic tissue cultures (P < 0.05), and the specificities were 90.9% and 96.4%, respectively. Sonication fluid culture detected more pathogens than peri-implant tissue culture (113 versus 71; P < 0.001), while polymicrobial infections were diagnosed by sonication fluid cultures and tissue cultures in 20.8% and 8% (P < 0.001), respectively. Microbiological diagnosis was achieved exclusively by sonication fluid cultures for 47 (90.4%) subjects, and among them, 18 (38.3%) had previously received antibiotics, whereas in five (9.6%) infected subjects, tissue culture was positive and the sonication fluid culture was negative. Among 39 (31.2%) OAI cases receiving antibiotics, the identification of the organisms occurred in 38.5% and 82.1% of the tissue and sonication fluid cultures, respectively (P < 0.049). We demonstrated that sonication fluid culture from removed osteosyntheses has the potential for improving the microbiological diagnosis of OAI. (AU)

• FAPESP's process: 10/15239-0 - Validation of the sonication method for the diagnosis of orthopedics implant-associated infections
• Grantee: Mauro José Costa Salles
• Support Opportunities: Regular Research Grants