A comparative study of heterogeneous antibiotic resistance of microbial populations in conventional periprosthetic tissu
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ORIGINAL ARTICLE
A comparative study of heterogeneous antibiotic resistance of microbial populations in conventional periprosthetic tissue cultures and sonication fluid cultures of orthopaedics explanted prostheses Angeliki Banousi1 · Dimitrios S. Evangelopoulos1 · Antonios Stylianakis2 · Emmanouil Fandridis3 · Sofia Chatziioannou4,5 · Nikolaos V. Sipsas6 · Spyridon G. Pneumaticos1 Received: 31 December 2019 / Accepted: 11 May 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background “Heterogeneity” describes a phenomenon where subpopulations of seemingly isogenic bacteria exhibit a range of susceptibilities to a particular antibiotic. We aim to investigate the frequency of heterogeneity among microbes isolated from infected prostheses, and its possible correlation with microbial resistance. Methods Between May 2014 and June 2019, we investigated 234 patients, at our institution, undergoing revision arthroplasty because of loosening of the prostheses or because of periprosthetic joint infection. All patients had periprosthetic tissue culture, sonication of prosthesis and direct inoculation of Sonication fluid into blood culture bottles. We assessed the presence of heterogeneity among all pathogens isolated from infected prostheses. Results Using standard non-microbiological criteria to determine periprosthetic joint infection, it was found that 143 patient (61.1%) had aseptic loosening while 91 patients (38.9%) had periprosthetic joint infection. Comparing the two methods, the results of our study showed that the method of sonication was significantly more sensitive than tissue culture [91% (83–96) vs. 43% (33–54); p 1.7 g/L or > 65% neutrophils in a knee prosthesis28 or leukocyte count > 4.2 g/L or > 80% neutrophils in a hip prosthesis) [14], (c) presence of visible purulence surrounding the prosthesis and (d) two or more positive intraoperative PTCs or positive SFC [15]. A sonication fluid culture was considered positive when it yielded > 50 colony-forming units (CFU)/ml of the same organism. However, when the patient had previously received antibiotics, any growth in the sonication fluid culture was considered positive. Previous antimicrobial therapy was defined as having received an antibiotic for ≥ 24 h in the 14 days prior to surgery. A postoperative infection was classified as “early” when PJI occurred within 3 months after implantation; as “delayed”, when PJI occurred between 3 and 24 months after implantation; and as “late” when PJI
European Journal of Orthopaedic Surgery & Traumatology
Three study groups were created. In the first stage, the sensitivity and specificity of microbial populations isolated from PTC are tested. In the second stage, the sensitivity and specificity of microbial populations isolated by SFC are tested. Finally, in the third stage, the sensitivity and specificity of microbes isolated from PTC and SFC will be studied (sonication-matching of antimicrobial resistance to standard antimicrobial drugs) [17].
individually homogenized in 3 mL trypticase
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