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Dithiotreitol pre-treatment of synovial fluid samples improves microbiological counts in peri-prosthetic joint
Lorenzo Drago1, Delia Romanò2, Andrea Fidanza3,4
1Clinical Microbiology, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
Purpose:
Synovial fluid cultures of periprosthetic joint infections (PJI) may be limited by bacteria living in the fluids as biofilm-aggregates. The antibiofilm pre-treatment of synovial fluids with dithiotreitol (DTT) could improve bacterial counts and microbiological early stage diagnosis in patients with suspected PJI.
Methods:
Synovial fluids collected from 57 subjects, affected by painful total hip or knee replacement, were divided into two aliquots, one pre-treated with DTT and one with normal saline. All samples were plated for microbial counts. Sensitivity of cultural examination and bacterial counts of pre-treated and control samples were then calculated and statistically compared.
Results:
Dithiothreitol pre-treatment led to a higher number of positive samples, compared to controls (27 vs 19), leading to a statistically significant increase in the sensitivity of the microbiological count examination from 54.3 to 77.1% and in colony-forming units count from 1884 ± 2.129 CFU/mL with saline pre-treatment to 20.442 ± 19.270 with DTT pre-treatment (P = 0.02).
Conclusions:
To our knowledge, this is the first report showing the ability of a chemical antibiofilm pre-treatment to increase the sensitivity of microbiological examination in the synovial fluid of patients with peri-prosthetic joint infection. If confirmed by larger studies, this finding may have a significant impact on routine microbiological procedures applied to synovial fluids and brings further support to the key role of bacteria living in biofilm-formed aggregates in joint infections.
Insights
Dithiothreitol (DTT) pre-treatment of synovial fluid improves bacterial detection in periprosthetic joint infections. This enhanced antibiofilm method increases diagnostic sensitivity for early-stage PJI detection.
Area of Science:
- Orthopedics
- Microbiology
- Infectious Diseases
Background:
- Periprosthetic joint infections (PJI) pose a significant challenge in orthopedic surgery.
- Bacterial biofilms in synovial fluid can hinder accurate microbiological diagnosis of PJI.
Purpose of the Study:
- To evaluate the efficacy of dithiotreitol (DTT) as an antibiofilm pre-treatment for synovial fluid.
- To determine if DTT pre-treatment enhances bacterial detection and improves early diagnosis of PJI.
Main Methods:
- Synovial fluid samples from 57 patients with suspected PJI were divided into two groups.
- One group was pre-treated with DTT, the other with normal saline.
- Microbial cultures were performed, and bacterial counts and diagnostic sensitivity were compared.
Main Results:
- DTT pre-treatment significantly increased the number of positive cultures (27 vs 19).
- Diagnostic sensitivity improved from 54.3% to 77.1% with DTT.
- Colony-forming unit counts increased significantly from 1884 ± 2129 to 20442 ± 19270 CFU/mL (P=0.02).
Conclusions:
- DTT pre-treatment is effective in increasing the sensitivity of microbiological examination of synovial fluid in PJI.
- This method may improve the early diagnosis of PJI by overcoming biofilm limitations.
- Further studies are needed to confirm these findings and their impact on routine diagnostics.
