title: Advantages of sonication fluid culture for the diagnosis of prosthetic joint infection.
abstract: OBJECTIVE
  The sensitivity of periprosthetic tissue culture is inadequate for the diagnosis of prosthetic joint infection (PJI). We investigated and compared the values of sonication fluid culture and periprosthetic tissue culture for diagnosing PJI.
  
  
  METHODS
  Included were patients whose joint prosthesis had been removed for any reason. The resulting sonication fluid and periprosthetic tissues were cultured for 14 days.
  
  
  RESULTS
  Of 231 explanted prostheses, aseptic failure was diagnosed in 162 cases (70%) and PJI in 69 (30%). In PJI cases, sonication fluid culture detected 62 microorganisms and periprosthetic tissue culture detected 45. Tissue and sonication fluid cultures showed sensitivities of 61% and 81%, respectively (p < 0.01), with specificity of 100% and 99%, respectively. On day 1, tissue and sonication fluid cultures were positive in 13% and 28% (p = 0.013) of PJI cases respectively, and on day 2, in 26% and 48% (p = 0.002) of cases. Four anaerobes grew in sonication fluid culture after 7-13 days incubation, whereas tissue culture missed 3 of these. Prolonged incubation of sonication fluid did not detect any organisms in the cases of aseptic failure.
  
  
  CONCLUSIONS
  Sonication fluid culture provides a more rapid diagnosis and detects about 30% more pathogens, although anaerobic organisms require up to 2 weeks of incubation.
authors.affiliation: Microbiology Laboratory, Laboratori de Referència de Catalunya, MasBlau I, El Prat de Llobregat, 08820 Barcelona, Spain. Electronic address: eportillo@lrc.es.
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Portillo
authors.affiliation: Microbiology Laboratory, Laboratori de Referència de Catalunya, MasBlau I, El Prat de Llobregat, 08820 Barcelona, Spain.
authors.forename: Margarita
authors.initials: M
authors.lastname: Salvadó
authors.affiliation: Department of Orthopedic Surgery, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Alier
authors.affiliation: Department of Orthopedic Surgery, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain.
authors.forename: Santos
authors.initials: S
authors.lastname: Martínez
authors.affiliation: Infectious Diseases Service, Department of Internal Medicine, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain.
authors.forename: Lluisa
authors.initials: L
authors.lastname: Sorli
authors.affiliation: Infectious Diseases Service, Department of Internal Medicine, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Horcajada
authors.affiliation: Department of Orthopedic Surgery, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Puig
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000175:diagnosis*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008828:Microbiological Techniques / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000382:microbiology*; D016459:Prosthesis-Related Infections / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D013010:Sonication / Q000379:methods*; D013048:Specimen Handling / Q000379:methods*; D013997:Time Factors
keywords: Periprosthetic tissue culture; Prosthetic joint infection; Sonication