title: 'All in a box' a concept for optimizing microbiological diagnostic sampling in prosthetic joint infections.
abstract: BACKGROUND
  Accurate microbial diagnosis is crucial for effective management of prosthetic joint infections. Culturing of multiple intraoperative tissue samples has increased diagnostic accuracy, but new preparatory techniques and molecular methods hold promise of further improvement. The increased complexity of sampling is, however, a tough challenge for surgeons and assistants in the operation theatre, and therefore we devised and tested a new concept of pre-packed boxes with a complete assortment of swabs, vials and additional tools needed in the operating theatre for non-standard samples during a clinical study of prosthetic joint infections.
  
  
  RESULTS
  The protocol for the clinical study required triplicate samples of joint fluid, periprosthetic tissue, bone tissue, and swabs from the surface of the prosthesis. Separate boxes were prepared for percutaneous joint puncture and surgical revision; the latter included containers for prosthetic components or the entire prosthesis. During a 2-year project period 164 boxes were used by the surgeons, 98 of which contained a complete set of samples. In all, 1508 (89%) of 1685 scheduled samples were received.
  
  
  CONCLUSIONS
  With this concept a high level of completeness of sample sets was achieved and thus secured a valid basis for evaluation of new diagnostics. Although enthusiasm for the project may have been a contributing factor, the extended project period suggests that the 'All in a box' concept is equally applicable in routine clinical settings with standardized but complex diagnostic sampling.
authors.affiliation: Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark. lone.l@rn.dk.
authors.forename: Lone Heimann
authors.initials: LH
authors.lastname: Larsen
authors.forename: Yijuan
authors.initials: Y
authors.lastname: Xu
authors.forename: Ole
authors.initials: O
authors.lastname: Simonsen
authors.forename: Christian
authors.initials: C
authors.lastname: Pedersen
authors.forename: Henrik C
authors.initials: HC
authors.lastname: Schønheyder
authors.forename: Trine Rolighed
authors.initials: TR
authors.lastname: Thomsen
mesh_terms: D001842:Bone and Bones / Q000382:microbiology; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis* / Q000382:microbiology; D008828:Microbiological Techniques / Q000295:instrumentation* / Q000379:methods; D019736:Prostheses and Implants / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000382:microbiology; D011677:Punctures / Q000295:instrumentation; D012086:Reoperation / Q000295:instrumentation; D015203:Reproducibility of Results; D013048:Specimen Handling / Q000295:instrumentation* / Q000379:methods; D013582:Synovial Fluid / Q000382:microbiology