The microbiology of periprosthetic joint infections as revealed by sonicate cultures in Korea: Routine use of fungal and mycobacterial cultures is necessary?

Autor: Lee Y; Department of Infectious Diseases, Chonnam National University Hospital, Gwang-ju, Republic of Korea., Lee A; Department of Infectious Diseases, Chonnam National University Hospital, Gwang-ju, Republic of Korea., Jeong HS; Department of Infectious Diseases, Chonnam National University Hospital, Gwang-ju, Republic of Korea., Shin SU; Department of Infectious Diseases, Chonnam National University Hospital, Gwang-ju, Republic of Korea., Kim UJ; Department of Infectious Diseases, Chonnam National University Hospital, Gwang-ju, Republic of Korea.; Department of Infectious Diseases, Chonnam National University Hospital Medical School, Gwang-ju, Republic of Korea., Kim SE; Department of Infectious Diseases, Chonnam National University Hospital, Gwang-ju, Republic of Korea.; Department of Infectious Diseases, Chonnam National University Hospital Medical School, Gwang-ju, Republic of Korea., Kang SJ; Department of Infectious Diseases, Chonnam National University Hospital, Gwang-ju, Republic of Korea.; Department of Infectious Diseases, Chonnam National University Hospital Medical School, Gwang-ju, Republic of Korea., Jung SI; Department of Infectious Diseases, Chonnam National University Hospital, Gwang-ju, Republic of Korea.; Department of Infectious Diseases, Chonnam National University Hospital Medical School, Gwang-ju, Republic of Korea., Park KS; Department of Orthopedic Surgery, Chonnam National University Hospital Medical School, Gwang-ju, Republic of Korea., Seon JK; Department of Orthopedic Surgery, Chonnam National University Hospital Medical School, Gwang-ju, Republic of Korea., Shin JH; Department of Laboratory Medicine, Chonnam National University Hospital Medical School, Gwang-ju, Republic of Korea., Park KH; Department of Infectious Diseases, Chonnam National University Hospital, Gwang-ju, Republic of Korea.; Department of Infectious Diseases, Chonnam National University Hospital Medical School, Gwang-ju, Republic of Korea.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Aug 15; Vol. 19 (8), pp. e0309046. Date of Electronic Publication: 2024 Aug 15 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0309046
Abstrakt: Background: Although sonication is a valuable diagnostic tool for periprosthetic joint infections (PJI), it is not commonly utilized. We analyzed sonicate and intraoperative tissue culture results obtained from three hospitals to define the microbial etiology of PJIs in Korea. Furthermore, we investigated necessity of conducting regular fungal and mycobacterial cultures.
Methods: We retrospectively analyzed data for patients with suspected orthopedic-related infections between 2017 and 2022, who had undergone prostheses removal surgery. We included 193 patients with suspected PJIs, and bacterial (n = 193), fungal (n = 193), and mycobacterial (n = 186) cultures were conducted on both sonicate and intraoperative tissue samples. The diagnosis of PJI was based on the European Bone and Joint Infection Society (EBJIS) criteria.
Results: Out of 193 patients, 121 (62.7%) had positive sonicate cultures, while 112 (58.0%) had positive periprosthetic tissue cultures. According to EBJIS criteria, a total of 181 patients were diagnosed with PJI, and 141 patients received microbiological confirmation through sonicate fluid culture or tissue culture. Of the 181 patients, 28 were classified with acute PJI (within 3 months of implantation) and 153 with chronic PJI. Among 141 patients, staphylococci were the most common organisms, accounting for 51.8% of cases, followed by Gram-negative organisms (15.6%), fungus (8.5%), and mycobacteria (3.5%). Nearly 91.7% of fungal isolates were Candida species, which also grew in bacterial cultures. In total, 11 cases cultured positive only in tissue culture, whereas 20 cases cultured positive only in sonicate culture. The antibiotic treatment plans were adjusted according to culture results.
Conclusions: Utilizing sonicate culture has greatly assisted in identifying pathogens responsible for chronic indolent PJIs, allowing suitable antimicrobial treatment. Based on few cases involving non-Candida and mycobacterial infections, it appears that routine fungal and mycobacterial cultures may not be necessary.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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