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Published on: December 3, 2017
Bacterial Colonization of Irrigation Fluid during Aseptic Revision Knee Arthroplasty
Michael Fuchs1, Matthias Pumberger2, Hagen Hommel3
1RKU University Department of Orthopaedics, University of Ulm, 89081 Ulm, Germany.
Abstract:
Surgical risk factors for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) are the subjects of ongoing research. It is unclear if there are specific locations of the surgical area that might act as a pathogen source. Due to the fact that bacterial replication occurs preferably under humid conditions, it was our aim to investigate if irrigation fluid reservoirs on the surgical covers are subject to bacterial colonization. We prospectively observed 40 patients with scheduled aseptic 1-stage TKA revision. At time intervals of 30 min, irrigation samples were tested for microbiological colonization. Additionally, the suction tip was investigated at the end of surgery. Overall, a bacterial detection rate of 25% was found (57/232 samples). Analysis for any positive microbial detection revealed pathogen findings of irrigation fluid in 41.7% of samples after 30 min with a constant increase up to 77.8% after 90 min. Twenty-three percent of suction tips showed bacterial colonization. Coagulase-negative staphylococci, accounting for the majority of PJI, were the predominant pathogens. After an average follow-up of 17 months, no PJI was confirmed. Despite the substantial bacterial load of irrigation fluid, PJI rates were not elevated. Nevertheless, we recommend that irrigation fluid reservoirs should be prevented and not withdrawn by suction.
Insights
Surgical irrigation fluid reservoirs can become colonized with bacteria during total knee arthroplasty (TKA) revisions. Despite this bacterial load, periprosthetic joint infection (PJI) rates were not elevated in this study.
Area of Science:
- Orthopedic surgery
- Infectious disease microbiology
Background:
- Periprosthetic joint infection (PJI) is a serious complication after total knee arthroplasty (TKA).
- Identifying surgical risk factors, including potential pathogen sources, is crucial for PJI prevention.
- Bacterial growth thrives in humid environments, prompting investigation into irrigation fluid reservoirs.
Purpose of the Study:
- To investigate bacterial colonization of irrigation fluid reservoirs during aseptic 1-stage TKA revision surgery.
- To determine if these reservoirs serve as a source of pathogens contributing to PJI.
Main Methods:
- Prospective observational study of 40 patients undergoing aseptic 1-stage TKA revision.
- Irrigation fluid samples collected at 30-minute intervals and suction tips analyzed post-surgery.
- Microbiological testing for bacterial colonization.
Main Results:
- A 25% overall bacterial detection rate was observed across all samples.
- Irrigation fluid showed increasing bacterial colonization, from 41.7% at 30 minutes to 77.8% at 90 minutes.
- Twenty-three percent of suction tips were colonized; coagulase-negative staphylococci were the predominant pathogens.
Conclusions:
- Surgical irrigation fluid reservoirs can harbor significant bacterial loads during TKA revision.
- Despite bacterial presence, no PJI cases were confirmed in this cohort.
- Recommendations include preventing irrigation fluid reservoirs and avoiding suctioning them.
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