title: How Many Samples and How Many Culture Media To Diagnose a Prosthetic Joint Infection: a Clinical and Microbiological Prospective Multicenter Study.
abstract: Although numerous perioperative samples and culture media are required to diagnose prosthetic joint infection (PJI), their exact number and types have not yet been definitely determined with a high level of proof. We conducted a prospective multicenter study to determine the minimal number of samples and culture media required for accurate diagnosis of PJI. Over a 2-year period, consecutive patients with clinical signs suggesting PJI were included, with five perioperative samples per patient. The bacteriological and PJI diagnosis criteria were assessed using a random selection of two, three, or four samples and compared with those obtained using the recommended five samples (references guidelines). The results obtained with two or three culture media were then compared with those obtained with five culture media for both criteria. The times-to-positivity of the different culture media were calculated. PJI was confirmed in 215/264 suspected cases, with a bacteriological criterion in 192 (89%). The PJI was monomicrobial (85%) or polymicrobial (15%). Percentages of agreement of 98.1% and 99.7%, respectively, for the bacteriological criterion and confirmed PJI diagnosis were obtained when four perioperative samples were considered. The highest percentages of agreement were obtained with the association of three culture media, a blood culture bottle, a chocolate agar plate, and Schaedler broth, incubated for 5, 7, and 14 days, respectively. This new procedure leads to significant cost saving. Our prospective multicenter study showed that four samples seeded on three culture media are sufficient for diagnosing PJI.
authors.affiliation: CHU Nantes, Laboratoire de Bactériologie, Nantes, France pascale.bemer@chu-nantes.fr.
authors.forename: Pascale
authors.initials: P
authors.lastname: Bémer
authors.affiliation: Inserm, CIC 1415, Tours, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Léger
authors.affiliation: CHU Brest, Laboratoire de Bactériologie, Brest, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Tandé
authors.affiliation: CHU Poitiers, Laboratoire de Bactériologie, Poitiers, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Plouzeau
authors.affiliation: CHU Tours, Laboratoire de Bactériologie, Tours, France.
authors.forename: Anne Sophie
authors.initials: AS
authors.lastname: Valentin
authors.affiliation: CHU Rennes, Laboratoire de Bactériologie, Rennes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Jolivet-Gougeon
authors.affiliation: CHU Angers, Laboratoire de Bactériologie, Angers, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Lemarié
authors.affiliation: CHU Angers, Laboratoire de Bactériologie, Angers, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Kempf
authors.affiliation: CHU Brest, Laboratoire de Bactériologie, Brest, France.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Héry-Arnaud
authors.affiliation: CH Orléans, Laboratoire de Bactériologie, Orléans, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bret
authors.affiliation: CHU Nantes, Laboratoire de Bactériologie, Nantes, France.
authors.forename: Marie Emmanuelle
authors.initials: ME
authors.lastname: Juvin
authors.affiliation: Inserm, CIC 1415, Tours, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Giraudeau
authors.affiliation: CHU Nantes, Laboratoire de Bactériologie, Nantes, France.
authors.forename: Stéphane
authors.identifier: http://orcid.org/0000-0003-3176-8111
authors.initials: S
authors.lastname: Corvec
authors.affiliation: CHU Poitiers, Laboratoire de Bactériologie, Poitiers, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Burucoa
mesh_terms: D001168:Arthritis / Q000175:diagnosis* / Q000382:microbiology*; D001431:Bacteriological Techniques / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000382:microbiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors