title: Sonication assisted microbiological diagnosis of implant-related infection caused by Prevotella disiens and Staphylococcus epidermidis in a patient with cranioplasty.
abstract: BACKGROUND
  Infections present a major complication of cranioplasty procedures and in many cases removal of the implant material becomes a necessity. Sonication of the artificial implant material has been used during the last years, in order to facilitate better diagnosis of these infections, nevertheless its use in cranial implant infections is still limited.
  
  
  METHODS
  A case of a 63-year-old Caucasian male patient who underwent a decompressive craniectomy, due to intracranial hemorrhage, and a consequent cranioplasty using an autogenic bone flap fixed by titanium clamps, is reported. After three unsuccessful cranioplasty efforts to repair a persistent skin defect, removing the bone flap and the titanium clamps was a necessity. Tissue and bone cultures were unable to reveal any microorganism whilst sonication of the removed titanium clamps and consequent culture of the resulting sonication liquid yielded Prevotella disiens and Staphylococcus epidermidis. The patient was treated with daptomycin and metronidazole until discharge and the skin defect was successfully repaired.
  
  
  CONCLUSIONS
  The present case report indicates that the use of the sonication procedure assisted the microbiological diagnosis. This is the first known neurosurgical case of the implementation of the sonication procedure.
authors.affiliation: Laboratory of Implant Infections, Department of Microbiology, "KAT" General Hospital, 14561, Athens, Greece. zzzendo@hotmail.com.
authors.forename: Pavlos C
authors.initials: PC
authors.lastname: Thomaidis
authors.affiliation: Department of Microbiology, "Laikon" General Hospital, 11527, Athens, Greece. pantaza@otenet.gr.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Pantazatou
authors.affiliation: Laboratory of Implant Infections, Department of Microbiology, "KAT" General Hospital, 14561, Athens, Greece. spyroskam@hotmail.com.
authors.forename: Spyros
authors.initials: S
authors.lastname: Kamariotis
authors.affiliation: Neurosurgery Department, "KAT" General Hospital, 14561, Athens, Greece. kivlachos@gmail.com.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vlachos
authors.affiliation: Plastic Surgery Department, "KAT" General Hospital, 14561, Athens, Greece. groussos73@gmail.com.
authors.forename: George
authors.initials: G
authors.lastname: Roussos
authors.affiliation: Plastic Surgery Department, "KAT" General Hospital, 14561, Athens, Greece. p-pan@otenet.gr.
authors.forename: Petros
authors.initials: P
authors.lastname: Panagiotou
authors.affiliation: Laboratory of Implant Infections, Department of Microbiology, "KAT" General Hospital, 14561, Athens, Greece. astylianakis@hotmail.com.
authors.forename: Antonios
authors.initials: A
authors.lastname: Stylianakis
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016866:Bacteroidaceae Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D017576:Daptomycin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D018720:Prevotella / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D019736:Prostheses and Implants / Q000382:microbiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012886:Skull / Q000187:drug effects / Q000382:microbiology / Q000601:surgery; D013010:Sonication; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D013212:Staphylococcus epidermidis / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D013524:Surgical Flaps; D014025:Titanium / Q000737:chemistry; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D014025:Titanium; D017576:Daptomycin