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Updated: May 9, 2025
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Published on: December 3, 2017
Enhancing diagnostic accuracy for periprosthetic joint infections with an alternative homogenization approach
Sofie Goes1, Annelies De Bel2, Michaël Boudewijns2
1Department of microbiology and infection control, Algemeen Ziekenhuis Groeninge, President Kennedylaan 4, Kortrijk, 8500, Belgium. sofie.goes@icloud.com.
Purpose:
In this study, we assessed the use of two commercial bead mills, ProbeAX (PBX) and ProbeAX Evolution (PBX-E, AxonLab). Additionally, we investigated the application of PBX in routine procedures and evaluated whether extended incubation in enrichment media, such as thioglycolate broths (THIO) and blood culture bottles (BCB), could enhance the microbiological diagnosis of periprosthetic infections (PJI) and fracture-related infections (FRI).
Methods:
The PBX and PBX-E were evaluated on the quantitative recovery of multiple microorganisms from spiked samples. For the comparison of the three methods, tissue samples from 87 individuals suspected of having PJI or FRI and requiring surgery were included in the study.
Results:
The added value of BCB and THIO, next to conventional culture (CC), was assessed by comparing the sensitivities of each technique, being 87.1% for CC, 96.8% for BCB, and 80.6% for THIO. The contamination rate of THIO (59.8% (52/87)) was significantly higher compared to CC (21.8% (19/87)) and BCB (17.2% (15/87)), resulting in the lowest specificity for THIO (20.0%), followed by CC (67.8%) and BCB (75.4%). The mean time-to-positivity (TTP) for BCB was 2.3 days, for CC 2.5 days, and 7.3 days for THIO (p <.001). Nonetheless, extended incubation was necessary to confirm all infections, particularly those caused by anaerobic bacteria.
Conclusion:
This study demonstrates that culturing tissue samples in BCB improves the diagnosis of PJI/FRI. Extended incubation for more than 5 days is only essential for detecting slow-growing bacteria, such as Cutibacterium acnes. Regarding the stability of different bacteria, the novel PBX-E demonstrated superior results. Time until inoculation, however, is critical to ensure optimal recovery.
Insights
Blood culture bottles (BCB) enhance the diagnosis of periprosthetic and fracture-related infections (PJI/FRI). While extended incubation aids slow-growing bacteria, timely inoculation is crucial for optimal microbial recovery.
Area of Science:
- Microbiology
- Infectious Diseases
- Biotechnology
Background:
- Periprosthetic joint infections (PJI) and fracture-related infections (FRI) pose significant challenges in orthopedic surgery.
- Accurate and timely microbiological diagnosis is critical for effective treatment and patient outcomes.
- Conventional culture methods may have limitations in detecting all causative pathogens.
Purpose of the Study:
- To evaluate the diagnostic performance of two commercial bead mills, ProbeAX (PBX) and ProbeAX Evolution (PBX-E).
- To assess the utility of enrichment media, specifically blood culture bottles (BCB) and thioglycolate broths (THIO), in improving the microbiological diagnosis of PJI and FRI.
- To determine the impact of extended incubation periods on diagnostic yield.
Main Methods:
- Quantitative recovery of microorganisms was assessed using PBX and PBX-E on spiked samples.
- Tissue samples from 87 patients with suspected PJI or FRI were cultured using conventional culture (CC), BCB, and THIO.
- Sensitivity, specificity, contamination rates, and time-to-positivity (TTP) were compared across methods.
Main Results:
- Blood culture bottles (BCB) demonstrated higher sensitivity (96.8%) compared to conventional culture (CC) (87.1%) and thioglycolate broths (THIO) (80.6%) for diagnosing PJI/FRI.
- THIO exhibited a significantly higher contamination rate (59.8%) and lower specificity (20.0%) than CC and BCB.
- BCB showed a shorter mean time-to-positivity (2.3 days) compared to CC (2.5 days) and THIO (7.3 days), though extended incubation was needed for slow-growing bacteria.
Conclusions:
- Culturing tissue samples in BCB significantly improves the diagnosis of PJI and FRI.
- Extended incubation beyond 5 days is primarily beneficial for detecting slow-growing organisms like Cutibacterium acnes.
- The ProbeAX Evolution (PBX-E) showed superior performance in bacterial stability, emphasizing the critical role of timely inoculation for optimal recovery.
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