TY - JOUR
T1 - Comparison of diagnostic accuracy of periprosthetic tissue culture in blood culture bottles to that of prosthesis sonication fluid culture for diagnosis of prosthetic joint infection (PJI) by use of Bayesian latent class modeling and IDSA PJI criteria for classification
AU - Yan, Qun
AU - Karau, Melissa J.
AU - Greenwood-Quaintance, Kerryl E.
AU - Mandrekar, Jayawant N.
AU - Osmon, Douglas R.
AU - Abdel, Matthew P.
AU - Patel, Robin
N1 - Publisher Copyright:
Copyright © 2018 American Society for Microbiology. All Rights Reserved.
PY - 2018/6
Y1 - 2018/6
N2 - We have previously demonstrated that culturing periprosthetic tissue in blood culture bottles (BCBs) improves sensitivity compared to conventional agar and broth culture methods for diagnosis of prosthetic joint infection (PJI). We have also shown that prosthesis sonication culture improves sensitivity compared to periprosthetic tissue culture using conventional agar and broth methods. The purpose of this study was to compare the diagnostic accuracy of tissue culture in BCBs (subsequently referred to as tissue culture) to prosthesis sonication culture (subsequently referred to as sonicate fluid culture). We studied 229 subjects who underwent arthroplasty revision or resection surgery between March 2016 and October 2017 at Mayo Clinic in Rochester, Minnesota. Using the Infectious Diseases Society of America (IDSA) PJI diagnostic criteria (omitting culture criteria) as the gold standard, the sensitivity of tissue culture was similar to that of the sonicate fluid culture (66.4% versus 73.1%, P 0.07) but was significantly lower than that of the two tests combined (66.4% versus 76.9%, P 0.001). Using Bayesian latent class modeling, which assumes no gold standard for PJI diagnosis, the sensitivity of tissue culture was slightly lower than that of sonicate fluid culture (86.3% versus 88.7%) and much lower than that of the two tests combined (86.3% versus 99.1%). In conclusion, tissue culture in BCBs reached sensitivity similar to that of prosthesis sonicate fluid culture for diagnosis of PJI, but the two tests combined had the highest sensitivity without compromising specificity. The combination of tissue culture in BCBs and sonicate fluid culture is recommended to achieve the highest level of microbiological diagnosis of PJI.
AB - We have previously demonstrated that culturing periprosthetic tissue in blood culture bottles (BCBs) improves sensitivity compared to conventional agar and broth culture methods for diagnosis of prosthetic joint infection (PJI). We have also shown that prosthesis sonication culture improves sensitivity compared to periprosthetic tissue culture using conventional agar and broth methods. The purpose of this study was to compare the diagnostic accuracy of tissue culture in BCBs (subsequently referred to as tissue culture) to prosthesis sonication culture (subsequently referred to as sonicate fluid culture). We studied 229 subjects who underwent arthroplasty revision or resection surgery between March 2016 and October 2017 at Mayo Clinic in Rochester, Minnesota. Using the Infectious Diseases Society of America (IDSA) PJI diagnostic criteria (omitting culture criteria) as the gold standard, the sensitivity of tissue culture was similar to that of the sonicate fluid culture (66.4% versus 73.1%, P 0.07) but was significantly lower than that of the two tests combined (66.4% versus 76.9%, P 0.001). Using Bayesian latent class modeling, which assumes no gold standard for PJI diagnosis, the sensitivity of tissue culture was slightly lower than that of sonicate fluid culture (86.3% versus 88.7%) and much lower than that of the two tests combined (86.3% versus 99.1%). In conclusion, tissue culture in BCBs reached sensitivity similar to that of prosthesis sonicate fluid culture for diagnosis of PJI, but the two tests combined had the highest sensitivity without compromising specificity. The combination of tissue culture in BCBs and sonicate fluid culture is recommended to achieve the highest level of microbiological diagnosis of PJI.
KW - Blood culture bottles
KW - PJI
KW - Periprosthetic tissue culture
KW - Prosthetic joint infection
KW - Sonicate fluid culture
UR - http://www.scopus.com/inward/record.url?scp=85047898324&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85047898324&partnerID=8YFLogxK
U2 - 10.1128/JCM.00319-18
DO - 10.1128/JCM.00319-18
M3 - Article
C2 - 29643202
AN - SCOPUS:85047898324
SN - 0095-1137
VL - 56
JO - Journal of clinical microbiology
JF - Journal of clinical microbiology
IS - 6
ER -