The role of implant sonication in the diagnosis of periprosthetic shoulder infection.
Adult
Aged
Arthritis, Infectious
/ diagnosis
Arthroplasty, Replacement, Shoulder
/ adverse effects
Female
Humans
Male
Middle Aged
Propionibacterium acnes
Prosthesis-Related Infections
/ diagnosis
Reoperation
Retrospective Studies
Sensitivity and Specificity
Shoulder Prosthesis
/ adverse effects
Sonication
Periprosthetic shoulder infection
diagnostic
sonication
tissue culture
Journal
Journal of shoulder and elbow surgery
ISSN: 1532-6500
Titre abrégé: J Shoulder Elbow Surg
Pays: United States
ID NLM: 9206499
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
29
06
2019
revised:
04
10
2019
accepted:
20
10
2019
pubmed:
12
1
2020
medline:
3
11
2020
entrez:
12
1
2020
Statut:
ppublish
Résumé
The aim of this study was to investigate the validity of implant sonication fluid cultures in the diagnosis of shoulder periprosthetic joint infection (PJI) compared with tissue culture. This was a retrospective case-control study analyzing all patients who underwent a revision surgery for any kind of suspected septic or aseptic event due to failed shoulder arthroplasty at our institution between July 2014 and December 2018. The diagnostic validity of implant sonication was analyzed on the basis of the last proposed definition criteria of the International Consensus Meeting and compared with standard tissue cultures. Of the 72 patients, a total of 28 (38.9%) were classified as infected. Of the 28 infected patients, 20 (71.4%) had an identified organism by tissue cultures, and Cutibacterium acnes was the most commonly isolated pathogen. The sensitivities of sonicate fluid (≥50 CFU/mL) and periprosthetic tissue culture for the diagnosis of periprosthetic shoulder infection were 36% and 61% (P = .016), and the specificities were 97.7% and 100% (P > .99), respectively. If no cutoff value was used in sonication culture, the sensitivity increased to 75% whereas the specificity dropped to 82%. Although there was no significant difference in sensitivity between tissue culture and the no-cutoff sonication fluid culture (61% vs. 75%, P = .125), the specificity of tissue culture was significantly higher (100% vs. 82%, P = .01). Tissue culture showed a higher sensitivity and specificity than implant sonication in the diagnosis of shoulder PJI and should remain the gold standard for microbiological diagnosis of shoulder PJI.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this study was to investigate the validity of implant sonication fluid cultures in the diagnosis of shoulder periprosthetic joint infection (PJI) compared with tissue culture.
METHODS
METHODS
This was a retrospective case-control study analyzing all patients who underwent a revision surgery for any kind of suspected septic or aseptic event due to failed shoulder arthroplasty at our institution between July 2014 and December 2018. The diagnostic validity of implant sonication was analyzed on the basis of the last proposed definition criteria of the International Consensus Meeting and compared with standard tissue cultures.
RESULTS
RESULTS
Of the 72 patients, a total of 28 (38.9%) were classified as infected. Of the 28 infected patients, 20 (71.4%) had an identified organism by tissue cultures, and Cutibacterium acnes was the most commonly isolated pathogen. The sensitivities of sonicate fluid (≥50 CFU/mL) and periprosthetic tissue culture for the diagnosis of periprosthetic shoulder infection were 36% and 61% (P = .016), and the specificities were 97.7% and 100% (P > .99), respectively. If no cutoff value was used in sonication culture, the sensitivity increased to 75% whereas the specificity dropped to 82%. Although there was no significant difference in sensitivity between tissue culture and the no-cutoff sonication fluid culture (61% vs. 75%, P = .125), the specificity of tissue culture was significantly higher (100% vs. 82%, P = .01).
CONCLUSION
CONCLUSIONS
Tissue culture showed a higher sensitivity and specificity than implant sonication in the diagnosis of shoulder PJI and should remain the gold standard for microbiological diagnosis of shoulder PJI.
Identifiants
pubmed: 31924518
pii: S1058-2746(19)30715-3
doi: 10.1016/j.jse.2019.10.011
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e222-e228Informations de copyright
Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.