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How Many Samples and How Many Culture Media To Diagnose a Prosthetic Joint Infection: a Clinical and Microbiological
Pascale Bémer1, Julie Léger2, Didier Tandé3
1CHU Nantes, Laboratoire de Bactériologie, Nantes, France pascale.bemer@chu-nantes.fr.
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.
Insights
Diagnosing prosthetic joint infection (PJI) can be streamlined. Four perioperative samples using three specific culture media are sufficient for accurate PJI diagnosis, reducing costs.
Area of Science:
- Orthopedics
- Infectious Diseases
- Clinical Microbiology
Background:
- Prosthetic joint infection (PJI) diagnosis requires multiple perioperative samples and culture media, but optimal numbers are unproven.
- Current diagnostic protocols for PJI lack definitive evidence regarding the minimal required sample size and media types.
- Accurate and efficient diagnosis of PJI is crucial for patient outcomes and healthcare resource management.
Purpose of the Study:
- To determine the minimum number of perioperative samples and culture media necessary for accurate prosthetic joint infection (PJI) diagnosis.
- To establish evidence-based guidelines for sample collection and culture media selection in PJI diagnostics.
- To evaluate the diagnostic accuracy of reduced sample/media protocols compared to current standards.
Main Methods:
- A prospective, multicenter study involving 264 patients with suspected PJI.
- Analysis of five perioperative samples per patient, comparing diagnostic accuracy with random selections of two, three, or four samples.
- Comparison of results using two or three culture media against five, assessing bacteriological and PJI diagnostic criteria.
Main Results:
- Four perioperative samples achieved high agreement (98.1% for bacteriological, 99.7% for confirmed PJI) compared to five samples.
- An optimal combination of three culture media (blood culture bottle, chocolate agar, Schaedler broth) incubated for specific durations yielded the highest agreement.
- The study confirmed PJI in 215/264 cases, with monomicrobial infections in 85% and polymicrobial in 15%.
Conclusions:
- Four perioperative samples and three specific culture media are sufficient for accurate prosthetic joint infection (PJI) diagnosis.
- This optimized approach offers significant cost savings while maintaining high diagnostic accuracy.
- The findings provide a new, evidence-based procedure for PJI diagnosis, improving efficiency and resource utilization.
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