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Updated: May 5, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Sonication of catheter tips for improved detection of microorganisms on external ventricular drains and
Gregory F Jost1, Morten Wasner1, Ethan Taub1
1Department of Neurosurgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland.
Abstract:
The diagnosis of infections involving internal or external neurosurgical drainage devices is challenging, and to our knowledge no single reliable microbiological test exists. We used sonication to study bacterial colonization in 14 explanted external ventricular drains (EVD) and 13 ventriculo-peritoneal shunt (VPS) devices. This technique dislodges biofilm bacteria from the surface of implanted materials before culture. Removed devices were sonicated in saline (40 kHz, 1 minute, 0.25 W/cm(2)), the resulting fluid was cultured aerobically and anaerobically at 37°C, and bacterial growth was counted. Ventricular cerebrospinal fluid (CSF) was cultured separately. In the EVD group, sonication cultures grew significantly more bacteria (64%, 9/14) than cultures of aspirated ventricular CSF (14%, 2/14). In the VPS group the difference was not significant. Positive sonication cultures of EVD catheters yielded a median of >100 colony forming units (CFU) (range, 60-800). For positive sonication cultures of VPS, the median was 1000 CFU (range, 20-100,000). All patients with bacteria in their CSF also had positive sonication cultures from the removed device. Of the five patients with sterile or presumably contaminated CSF cultures but positive sonication cultures of removed shunts, one became afebrile after removal of the EVD, two developed meningitis and two remained asymptomatic. Sonication culture of EVD appears to improve the microbiological assessment of device-related infection and it corroborates with CSF cultures of revision surgery for VPS. Sonication of the removed EVD tip may raise awareness for the onset of meningitis.
Insights
Sonication of neurosurgical drainage devices significantly improves bacterial detection compared to cerebrospinal fluid cultures, aiding in the diagnosis of device-related infections. This method enhances the microbiological assessment for external ventricular drains and shunt revisions.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Microbiology
Background:
- Diagnosing infections associated with neurosurgical drainage devices like external ventricular drains (EVD) and ventriculo-peritoneal shunts (VPS) is challenging.
- Current microbiological tests lack reliability for detecting device-related infections.
- Biofilm formation on implanted devices complicates accurate bacterial identification.
Purpose of the Study:
- To evaluate the efficacy of sonication as a method for detecting bacterial colonization on explanted EVD and VPS devices.
- To compare the diagnostic yield of sonication cultures with conventional cerebrospinal fluid (CSF) cultures.
- To assess the clinical significance of positive sonication cultures in diagnosing device-related infections.
Main Methods:
- Sonication of 14 explanted EVD and 13 VPS devices in saline (40 kHz, 1 minute, 0.25 W/cm(2)) to dislodge biofilm bacteria.
- Aerobic and anaerobic culture of sonication fluid at 37°C, with bacterial growth quantification.
- Separate culture of ventricular CSF samples for comparison.
Main Results:
- Sonication cultures detected significantly more bacteria in EVD devices (64%) compared to CSF cultures (14%).
- In VPS devices, the difference between sonication and CSF cultures was not statistically significant.
- Positive sonication cultures from EVD catheters yielded a median of >100 CFU, while VPS yielded a median of 1000 CFU.
Conclusions:
- Sonication culture of EVDs significantly improves microbiological assessment for device-related infections.
- This technique corroborates with CSF cultures in VPS revision surgery.
- Sonication of EVD tips may enhance early detection of meningitis.
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