Sonication of removed hip and knee prostheses for diagnosis of infection

Andrej Trampuz, Kerryl E. Piper, Melissa J. Jacobson, Arlen D. Hanssen, Krishnan K. Unni, Douglas R. Osmon, Jayawant Mandrekar, Franklin R. Cockerill, James M. Steckelberg, James F Greenleaf, Robin Patel

Research output: Contribution to journalArticle

767 Citations (Scopus)

Abstract

BACKGROUND: Culturing of samples of periprosthetic tissue is the standard method used for the microbiologic diagnosis of prosthetic-joint infection, but this method is neither sensitive nor specific. In prosthetic-joint infection, microorganisms are typically present in a biofilm on the surface of the prosthesis. We hypothesized that culturing of samples obtained from the prosthesis would improve the microbiologic diagnosis of prosthetic-joint infection. METHODS: We performed a prospective trial comparing culture of samples obtained by sonication of explanted hip and knee prostheses to dislodge adherent bacteria from the prosthesis with conventional culture of periprosthetic tissue for the microbiologic diagnosis of prosthetic-joint infection among patients undergoing hip or knee revision or resection arthroplasty. RESULTS: We studied 331 patients with total knee prostheses (207 patients) or hip prostheses (124 patients); 252 patients had aseptic failure, and 79 had prosthetic-joint infection. With the use of standardized nonmicrobiologic criteria to define prosthetic-joint infection, the sensitivities of periprosthetic-tissue and sonicate-fluid cultures were 60.8% and 78.5% (P<0.001), respectively, and the specificities were 99.2% and 98.8%, respectively. Fourteen cases of prosthetic-joint infection were detected by sonicate-fluid culture but not by prosthetic-tissue culture. In patients receiving antimicrobial therapy within 14 days before surgery, the sensitivities of periprosthetic tissue and sonicate-fluid culture were 45.0% and 75.0% (P<0.001), respectively. CONCLUSIONS: In this study, culture of samples obtained by sonication of prostheses was more sensitive than conventional periprosthetic-tissue culture for the microbiologic diagnosis of prosthetic hip and knee infection, especially in patients who had received antimicrobial therapy within 14 days before surgery.

Original languageEnglish (US)
Pages (from-to)654-663
Number of pages10
JournalNew England Journal of Medicine
Volume357
Issue number7
DOIs
StatePublished - Aug 16 2007

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Knee Prosthesis
Hip Prosthesis
Sonication
Joints
Infection
Prostheses and Implants
Ambulatory Surgical Procedures
Hip
Knee
Biofilms
Arthroplasty
Bacteria

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Trampuz, A., Piper, K. E., Jacobson, M. J., Hanssen, A. D., Unni, K. K., Osmon, D. R., ... Patel, R. (2007). Sonication of removed hip and knee prostheses for diagnosis of infection. New England Journal of Medicine, 357(7), 654-663. https://doi.org/10.1056/NEJMoa061588

Sonication of removed hip and knee prostheses for diagnosis of infection. / Trampuz, Andrej; Piper, Kerryl E.; Jacobson, Melissa J.; Hanssen, Arlen D.; Unni, Krishnan K.; Osmon, Douglas R.; Mandrekar, Jayawant; Cockerill, Franklin R.; Steckelberg, James M.; Greenleaf, James F; Patel, Robin.

In: New England Journal of Medicine, Vol. 357, No. 7, 16.08.2007, p. 654-663.

Research output: Contribution to journalArticle

Trampuz, A, Piper, KE, Jacobson, MJ, Hanssen, AD, Unni, KK, Osmon, DR, Mandrekar, J, Cockerill, FR, Steckelberg, JM, Greenleaf, JF & Patel, R 2007, 'Sonication of removed hip and knee prostheses for diagnosis of infection', New England Journal of Medicine, vol. 357, no. 7, pp. 654-663. https://doi.org/10.1056/NEJMoa061588
Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR et al. Sonication of removed hip and knee prostheses for diagnosis of infection. New England Journal of Medicine. 2007 Aug 16;357(7):654-663. https://doi.org/10.1056/NEJMoa061588
Trampuz, Andrej ; Piper, Kerryl E. ; Jacobson, Melissa J. ; Hanssen, Arlen D. ; Unni, Krishnan K. ; Osmon, Douglas R. ; Mandrekar, Jayawant ; Cockerill, Franklin R. ; Steckelberg, James M. ; Greenleaf, James F ; Patel, Robin. / Sonication of removed hip and knee prostheses for diagnosis of infection. In: New England Journal of Medicine. 2007 ; Vol. 357, No. 7. pp. 654-663.
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abstract = "BACKGROUND: Culturing of samples of periprosthetic tissue is the standard method used for the microbiologic diagnosis of prosthetic-joint infection, but this method is neither sensitive nor specific. In prosthetic-joint infection, microorganisms are typically present in a biofilm on the surface of the prosthesis. We hypothesized that culturing of samples obtained from the prosthesis would improve the microbiologic diagnosis of prosthetic-joint infection. METHODS: We performed a prospective trial comparing culture of samples obtained by sonication of explanted hip and knee prostheses to dislodge adherent bacteria from the prosthesis with conventional culture of periprosthetic tissue for the microbiologic diagnosis of prosthetic-joint infection among patients undergoing hip or knee revision or resection arthroplasty. RESULTS: We studied 331 patients with total knee prostheses (207 patients) or hip prostheses (124 patients); 252 patients had aseptic failure, and 79 had prosthetic-joint infection. With the use of standardized nonmicrobiologic criteria to define prosthetic-joint infection, the sensitivities of periprosthetic-tissue and sonicate-fluid cultures were 60.8{\%} and 78.5{\%} (P<0.001), respectively, and the specificities were 99.2{\%} and 98.8{\%}, respectively. Fourteen cases of prosthetic-joint infection were detected by sonicate-fluid culture but not by prosthetic-tissue culture. In patients receiving antimicrobial therapy within 14 days before surgery, the sensitivities of periprosthetic tissue and sonicate-fluid culture were 45.0{\%} and 75.0{\%} (P<0.001), respectively. CONCLUSIONS: In this study, culture of samples obtained by sonication of prostheses was more sensitive than conventional periprosthetic-tissue culture for the microbiologic diagnosis of prosthetic hip and knee infection, especially in patients who had received antimicrobial therapy within 14 days before surgery.",
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T1 - Sonication of removed hip and knee prostheses for diagnosis of infection

AU - Trampuz, Andrej

AU - Piper, Kerryl E.

AU - Jacobson, Melissa J.

AU - Hanssen, Arlen D.

AU - Unni, Krishnan K.

AU - Osmon, Douglas R.

AU - Mandrekar, Jayawant

AU - Cockerill, Franklin R.

AU - Steckelberg, James M.

AU - Greenleaf, James F

AU - Patel, Robin

PY - 2007/8/16

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N2 - BACKGROUND: Culturing of samples of periprosthetic tissue is the standard method used for the microbiologic diagnosis of prosthetic-joint infection, but this method is neither sensitive nor specific. In prosthetic-joint infection, microorganisms are typically present in a biofilm on the surface of the prosthesis. We hypothesized that culturing of samples obtained from the prosthesis would improve the microbiologic diagnosis of prosthetic-joint infection. METHODS: We performed a prospective trial comparing culture of samples obtained by sonication of explanted hip and knee prostheses to dislodge adherent bacteria from the prosthesis with conventional culture of periprosthetic tissue for the microbiologic diagnosis of prosthetic-joint infection among patients undergoing hip or knee revision or resection arthroplasty. RESULTS: We studied 331 patients with total knee prostheses (207 patients) or hip prostheses (124 patients); 252 patients had aseptic failure, and 79 had prosthetic-joint infection. With the use of standardized nonmicrobiologic criteria to define prosthetic-joint infection, the sensitivities of periprosthetic-tissue and sonicate-fluid cultures were 60.8% and 78.5% (P<0.001), respectively, and the specificities were 99.2% and 98.8%, respectively. Fourteen cases of prosthetic-joint infection were detected by sonicate-fluid culture but not by prosthetic-tissue culture. In patients receiving antimicrobial therapy within 14 days before surgery, the sensitivities of periprosthetic tissue and sonicate-fluid culture were 45.0% and 75.0% (P<0.001), respectively. CONCLUSIONS: In this study, culture of samples obtained by sonication of prostheses was more sensitive than conventional periprosthetic-tissue culture for the microbiologic diagnosis of prosthetic hip and knee infection, especially in patients who had received antimicrobial therapy within 14 days before surgery.

AB - BACKGROUND: Culturing of samples of periprosthetic tissue is the standard method used for the microbiologic diagnosis of prosthetic-joint infection, but this method is neither sensitive nor specific. In prosthetic-joint infection, microorganisms are typically present in a biofilm on the surface of the prosthesis. We hypothesized that culturing of samples obtained from the prosthesis would improve the microbiologic diagnosis of prosthetic-joint infection. METHODS: We performed a prospective trial comparing culture of samples obtained by sonication of explanted hip and knee prostheses to dislodge adherent bacteria from the prosthesis with conventional culture of periprosthetic tissue for the microbiologic diagnosis of prosthetic-joint infection among patients undergoing hip or knee revision or resection arthroplasty. RESULTS: We studied 331 patients with total knee prostheses (207 patients) or hip prostheses (124 patients); 252 patients had aseptic failure, and 79 had prosthetic-joint infection. With the use of standardized nonmicrobiologic criteria to define prosthetic-joint infection, the sensitivities of periprosthetic-tissue and sonicate-fluid cultures were 60.8% and 78.5% (P<0.001), respectively, and the specificities were 99.2% and 98.8%, respectively. Fourteen cases of prosthetic-joint infection were detected by sonicate-fluid culture but not by prosthetic-tissue culture. In patients receiving antimicrobial therapy within 14 days before surgery, the sensitivities of periprosthetic tissue and sonicate-fluid culture were 45.0% and 75.0% (P<0.001), respectively. CONCLUSIONS: In this study, culture of samples obtained by sonication of prostheses was more sensitive than conventional periprosthetic-tissue culture for the microbiologic diagnosis of prosthetic hip and knee infection, especially in patients who had received antimicrobial therapy within 14 days before surgery.

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