title: Diagnosis of spacer-associated infection using quantitative cultures from sonicated antibiotics-loaded spacers: implications for the clinical outcome.
abstract: Recent studies showed that a positive microbiological result from sonication of the PMMA spacer was associated with poor outcome of patients, but no quantitative analysis has yet been performed. For this purpose, a prospective analysis of 50 spacers (46 patients) was performed. All spacers were processed according to a previously described protocol, including centrifugation and quantitative culture. Clinical data and outcome were also analysed. A statistical relationship between the results of the cultures and the outcome of the patient was assessed. Sixteen patients were diagnosed with spacer-associated infection. Thirteen out of 50 spacers gave a positive culture. Nine of 13 presented with growth of an organism not isolated in the first-stage cultures, and in 7 out of 13 the organisms count was high (>10,000 CFU/ml). We have detected a significant statistical relationship between poor outcome and positive cultures, high colony counts, isolation of different organisms, positive periprosthetic cultures and spacer-associated infection. The detection in a sonicated, antibiotic-loaded PMMA spacer of organisms other than those isolated in the first surgical samples or high colony counts of any organisms is diagnostic with regard to spacer-associated infection.
authors.affiliation: Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040, Madrid, Spain. jestebanmoreno@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Esteban
authors.affiliation: Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Gadea
authors.affiliation: Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Pérez-Jorge
authors.affiliation: Department of Orthopaedics, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Sandoval
authors.affiliation: Department of Internal Medicine-Emergencies, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: García-Cañete
authors.affiliation: Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Fernandez-Roblas
authors.affiliation: Department of Internal Medicine-Emergencies, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Blanco
authors.affiliation: Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos 2, 28040, Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Prieto-Borja
authors.affiliation: Department of Orthopaedics, Hospital Universitario La Princesa, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Cordero-Ampuero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015373:Bacterial Typing Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000401:mortality; D013010:Sonication / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents