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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_19 | Pages 44 - 44
22 Nov 2024
De Bleeckere A Neyt J Vandendriessche S Boelens J Coenye T
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Aim

Fast and accurate identification of pathogens causing periprosthetic joint infections (PJI) is essential to initiate effective antimicrobial treatment. Culture-based approaches frequently yield false negative results, despite clear signs of infection. This may be due to the use of general growth media, which do not mimic the conditions at site of infection. Possible alternative approaches include DNA-based techniques, the use of in vivo-like media and isothermal microcalorimetry (ITC). We developed a synthetic synovial fluid (SSF) medium that closely resembles the in vivo microenvironment and allows to grow and study PJI pathogens in physiologically relevant conditions. In this study we investigated whether the use of ITC in combination with the SSF medium can improve accuracy and time to detection in the context of PJI.

Methods

In this study, 120 synovial fluid samples were included, aspirated from patients with clinical signs of PJI. For these samples microbiology data (obtained in the clinical microbiology lab using standard procedures) and next generation sequencing (NGS) data, were available. The samples were incubated in the SSF medium at different oxygen levels (21% O2, 3% O2 and 0% O2) for 10 days. Every 24h, the presence of growth was checked. From positive samples, cultures were purified on Columbia blood agar and identified using MALDI-TOF. In parallel, heat produced by metabolically active microorganisms present in the samples was measured using ITC (calScreener, Symcel), (96h at 37°C, in SSF, BHI and thioglycolate). From the resulting thermograms the ‘time to activity’ could be derived. The accuracy and time to detection were compared between the different detection methods.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_14 | Pages 45 - 45
1 Dec 2019
Huard M Detrembleur C Poilvache H van Cauter M Driesen R Yombi J Neyt J Cornu O
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Aim

Apart from other biomarkers isolated in the synovial fluid, alpha-defensin appears to be a promising diagnostic tool to confirm a periprosthetic joint infection (PJI) in the hip or knee. The purpose of this study was to evaluate the sensitivity and specificity of an alpha defensin lateral flow (ADLF) test compared to usual standard classifications in the diagnostic management of PJI.

Method

This investigation was set up as a multicenter prospective cohort study. Synovial fluid was obtained by means of joint aspiration or intra-operative tissue biopsies. A presumptive PJI diagnosis was made according to criteria outlined by the Musculoskeletal Infection Society (MSIS), the Infectious Diseases Society of America (IDSA) and the European Bone and Joint Infection Society (EBJIS). The intention to treat by the surgeon was logged. Sensibility and specificity for the ADLF test was plotted for each aforementioned diagnostic algorithm. Spearman correlations between all scores were analyzed. Multiple logistic regression was used to determine the contribution of independent variables to the probability of PJI.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_14 | Pages 47 - 47
1 Dec 2019
Vermuyten L McPherson EJ Neyt J
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Aim

At present, a variety of clinical guidelines for treatment of periprosthetic joint infections (PJI) inevitably lead to a variety in outcomes by differing case management. Ideally a treatment algorithm should incorporate all components contributing to the decision-making process for a patient tailored solution in PJI. We aim to present a comprehensive and reproducible treatment algorithm based on a validated staging system, a thorough understanding of the host, the causative microbiome and implant complexity.

Method

The diagnosis of a PJI was defined according to major and minor criteria following revised International Consensus Symposium algorithm

The validated McPherson staging system was used in our university hospital from January 2015 until January 2019 in referred PJI patients. Standardised preoperative and postoperative survey documents were completed in order to register data from the patient's medical, social and surgical history. The complexity of the infected implant was taken into consideration, including quantity of preceding procedures, residual bone stock, type of fixation, magnitude of prosthetic components and presence or absence of reconstructive options. Further, preoperatively obtained bacteriological information by means of arthrocentesis or tissue/bone biopsies was categorized according to the mono- or polybacterial nature and to the qualification of virulence and difficulties to treat. Social and professional history, financial impediments and patient's functional outcome wishes were included in the joint decision making.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 87 - 87
1 Dec 2017
Stragier B Renard A Vanlaer L Verhaegen J Neyt J
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Aim

The purpose of this single center study was to analyze the robustness and thoroughness of debridement and irrigation in first stage procedures for periprosthetic joint infections in which the latter had been confirmed by fulfilling the PJI criteria produced by the musculoskeletal infection society.

Method

After introduction of ‘a clean phase’ concept in our center, we developed a method of using new instrumentation sets and waterproof cover sheets as well as sets of gloves and aprons after thorough debridement followed by copious irrigation under a splash sheet, once the prosthetic components were removed during which several (6 to 8) tissue biopsies and cultures were harvested. ‘Clean phase’ tissue specimens ad random were again obtained and cultured and compared with ‘dirty phase’ cultures and sonication results. Our zero hypothesis was that we were not able to entirely eradicate bacterial colonization. We tested this hypothesis during a period of 18 months in a consecutive series of first stage revisions for PJI at our center after introduction of the clean phase concept.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_23 | Pages 8 - 8
1 Dec 2016
Declercq P Goris S Neyt J Wauters J Spriet I
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Aim

Preoperative joint aspiration cultures (PJACs) are of great value in diagnosing prosthetic joint infections (PJIs). Studies investigating the predictive value of PJACs to identify causative pathogens in PJI, which is off course relevant for the correct initiation of antimicrobial treatment, are limited. The objective of this study was to investigate whether the PJACs are in agreement with causative pathogens in PJIs.

Method

A retrospective monocentric study was conducted at the 40-bed orthopedics department of a tertiary centre. Medical files of patients with proven prosthetic knee or hip infection with PJACs from maximum 6 months prior to the first stage of a two-stage revision admitted between March 2010 and December 2014 were evaluated. A proven PJI was defined as at least two positive preoperative or intraoperative cultures, the presence of purulent synovial fluid or purulence at the implant site or surrounding the prosthesis without other identifiable causes, the presence of acute inflammation upon histopathological examination of the periprosthetic tissue at the time of surgery or the presence of a sinus tract communicating with the prosthesis. In order to identify the causative pathogen(s) per patient, a multidisciplinary team, consisting out of a microbiologist, a septic orthopedic surgeon, two infectious diseases specialists and two clinical pharmacists, assessed the relevance of pathogens cultured in the PJACs and intraoperative deep samples based on the current 2012 IDSA guidelines. Per patient, agreement of PJACs corresponding to the retained causative pathogen(s) was investigated in two ways: 1) on species level and 2) on Gram stain or fungi level.