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Can pre-analytical procedures improve microbiological culture yield in patients with periprosthetic infections?
Juliane Käschner1, Christoph Theil2, Georg Gosheger1
1Department of General Orthopaedics and Tumor Orthopaedics, University Hospital Münster, Münster, Germany.
Background:
The detection of causative pathogens plays a crucial role in the diagnosis and targeted treatment of periprosthetic joint infections (PJI). While there have been improvements in analytic methods in the past, pre-analytical procedures have not yet been sufficiently investigated. The objective of this study was to compare the culture yield of four different pre-analytical procedures.
Methods:
Patients with perioperative diagnosis of PJI were included in a single center cross-sectional study (2021-2022). Tissue samples (n = 20) of each patient were randomly and equally distributed to each of the four study arms. Tissue samples were either send to the laboratory without culture medium (group A) or were transported in thioglycolate medium immediately after sampling at three different temperatures (room temperature, 4 °C, 37° for 24 h; group B-D). Culture media were investigated for growth on days 1, 3, 7, 12, 14. All organisms, the number of positive samples and the time to positivity were recorded and compared between the study arms. Single positive cultures were considered as contamination.
Results:
In total, 71 patients were included. The proportions of culture negative samples (10-15%) and polymicrobial infections (51-54%) were comparable between the four arms. Seven patients (10%) were culture-negative in group A, but showed growth in thioglycolate media (group B-D). Furthermore, 13% of patients showed growth in all groups, but additional organisms were cultured in thioglycolate. There was growth beyond day 7 of culturing only in thioglycolate, but not in group A. A storage temperature of 4 °C showed a longer time to positivity compared to the other groups (p < 0.001).
Conclusions:
Pre-analytical storage of tissue samples in thioglycolate broth did not improve the culture yield and did not detect additional cases of infection compared to the standard (pre-analytical storage in sterile containers). However, including a thioglycolate medium to the sampling algorithm reduced the rate of culture-negative infections and helped to identify additional organisms.
Insights
Storing periprosthetic joint infection (PJI) tissue samples in thioglycolate medium did not increase overall culture yield but did reduce culture-negative results and identified more organisms. This impacts infection diagnosis and treatment strategies.
Area of Science:
- Microbiology
- Orthopedic Surgery
- Infectious Diseases
Background:
- Accurate pathogen detection is vital for diagnosing and treating periprosthetic joint infections (PJI).
- While analytical methods have advanced, pre-analytical procedures for sample handling require further investigation.
- This study aimed to compare the effectiveness of four pre-analytical procedures on culture yield.
Purpose of the Study:
- To compare the culture yield of four different pre-analytical procedures for periprosthetic joint infection (PJI) diagnosis.
- To evaluate the impact of thioglycolate medium and storage temperature on microbial detection.
- To assess the influence of pre-analytical methods on identifying causative pathogens in PJI.
Main Methods:
- A cross-sectional study involving 71 patients diagnosed with PJI.
- Tissue samples were divided into four groups: sterile container (A) or thioglycolate medium at room temperature, 4°C, or 37°C for 24 hours (B-D).
- Cultures were monitored for growth, and positive samples, number of organisms, and time to positivity were recorded and compared.
Main Results:
- Thioglycolate medium did not significantly improve overall culture yield but reduced culture-negative results (10% vs. no thioglycolate).
- Additional organisms were identified in 13% of samples cultured with thioglycolate.
- Growth beyond day 7 was only observed in thioglycolate media, and 4°C storage led to a longer time to positivity.
Conclusions:
- Pre-analytical storage in thioglycolate broth did not enhance overall culture yield for PJI but reduced culture-negative infections.
- Incorporating thioglycolate medium into the sampling process aids in identifying additional organisms.
- Standard pre-analytical storage in sterile containers remains comparable in overall yield, but thioglycolate offers benefits in detecting polymicrobial infections.
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