Improved Diagnosis of Prosthetic Joint Infection by Culturing Periprosthetic Tissue Specimens in Blood Culture Bottles.
Improved Diagnosis of Prosthetic Joint Infection by Culturing Periprosthetic Tissue Specimens in Blood Culture Bottles.
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DOI：
10.1128/mbio.01776-15
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发表时间：
2016-01-05
期刊：
影响因子：
6.4
通讯作者：
Patel R
中科院分区：
文献类型：
--
作者：
Peel TN;Dylla BL;Hughes JG;Lynch DT;Greenwood-Quaintance KE;Cheng AC;Mandrekar JN;Patel R
尽管已知敏感性低，但在琼脂和肉汤中培养假体周围组织标本是常规的。在血培养瓶（BCB）中培养假体周围组织样本可能更方便，但其评价有限，尚未被广泛采用。本研究的目的是比较假体周围组织标本接种到血液培养瓶与标准琼脂和巯基乙酸盐肉汤培养的敏感性和特异性，应用贝叶斯潜在类模型（LCM），除了应用美国传染病学会（IDSA）的人工关节感染的标准。这项前瞻性队列研究在马约诊所（罗切斯特，MN）进行，为期9个月（2013年8月至2014年4月），包括所有接受翻修关节置换术的连续患者。总体而言，研究了369例受试者; 117例（32%）符合IDSA人工关节感染标准，82%患有晚期慢性感染。应用LCM，将组织接种到BCB中，与传统琼脂和肉汤培养物的灵敏度相比，灵敏度提高了47%（分别为92.1%和62.6%）;当应用IDSA标准时，这种变化幅度相似（分别为60.7%和44.4%; P = 0.003）。使用BCB的微生物检测时间短于使用标准培养基的微生物检测时间（P < 0.0001），需氧和厌氧BCB分别在中位数21和23小时内产生阳性结果。我们的研究结果表明，在血培养瓶中进行假体周围组织培养的半自动化方法比琼脂和巯基乙酸盐肉汤培养更敏感，且具有更高的特异性，且结果更快。人工关节感染是关节成形术的一个毁灭性的并发症。尽管如此，目前用于检测和诊断感染的微生物学技术是不完善的。这项研究探讨了一种新的方法来诊断感染，通过接种组织样本从周围的假体关节到血培养瓶。这项研究表明，与目前的实验室实践相比，这种新技术增加了感染的检测。这些发现对于患者护理非常重要，可以及时准确地诊断感染。
Despite known low sensitivity, culture of periprosthetic tissue specimens on agars and in broths is routine. Culture of periprosthetic tissue samples in blood culture bottles (BCBs) is potentially more convenient, but it has been evaluated in a limited way and has not been widely adopted. The aim of this study was to compare the sensitivity and specificity of inoculation of periprosthetic tissue specimens into blood culture bottles with standard agar and thioglycolate broth culture, applying Bayesian latent class modeling (LCM) in addition to applying the Infectious Diseases Society of America (IDSA) criteria for prosthetic joint infection. This prospective cohort study was conducted over a 9-month period (August 2013 to April 2014) at the Mayo Clinic, Rochester, MN, and included all consecutive patients undergoing revision arthroplasty. Overall, 369 subjects were studied; 117 (32%) met IDSA criteria for prosthetic joint infection, and 82% had late chronic infection. Applying LCM, inoculation of tissues into BCBs was associated with a 47% improvement in sensitivity compared to the sensitivity of conventional agar and broth cultures (92.1 versus 62.6%, respectively); this magnitude of change was similar when IDSA criteria were applied (60.7 versus 44.4%, respectively; P = 0.003). The time to microorganism detection was shorter with BCBs than with standard media (P < 0.0001), with aerobic and anaerobic BCBs yielding positive results within a median of 21 and 23 h, respectively. Results of our study demonstrate that the semiautomated method of periprosthetic tissue culture in blood culture bottles is more sensitive than and as specific as agar and thioglycolate broth cultures and yields results faster. Prosthetic joint infections are a devastating complication of arthroplasty surgery. Despite this, current microbiological techniques to detect and diagnose infections are imperfect. This study examined a new approach to diagnosing infections, through the inoculation of tissue samples from around the prosthetic joint into blood culture bottles. This study demonstrated that, compared to current laboratory practices, this new technique increased the detection of infection. These findings are important for patient care to allow timely and accurate diagnosis of infection.