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

• Published in: Journal of clinical microbiology Vol. 52; no. 12; pp. 4176 - 4182
• Main Authors: Yano, Maysa Harumi, Klautau, Giselle Burlamaqui, da Silva, Cely Barreto, Nigro, Stanley, Avanzi, Osmar, Mercadante, Marcelo Tomanink, Salles, Mauro Jose Costa
• Format: Journal Article
• Language: English
• Published: United States American Society for Microbiology 01.12.2014
• Subjects: Adolescent; Adult; Bacteriology; Child; Female; Fracture Fixation - adverse effects; Humans; Male; Microbiological Techniques - methods; Middle Aged; Prosthesis-Related Infections - diagnosis; Sensitivity and Specificity; Sonication - methods; Young Adult
• ISSN: 0095-1137; 1098-660X; 1098-660X
• DOI: 10.1128/JCM.02140-14

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.