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Early detection of viable microorganisms in "sterile" periprosthetic fluids in implant-based breast reconstruction: A
Monari Marta1, Vaccari Stefano2, Lupacchini Alessandro Marco3
1Laboratory of Clinical Analysis, Humanitas Mater Domini, Castellanza, Varese, Italy.
Background:
Early postoperative infections are an important complication after postmastectomy implant-based breast reconstruction with current diagnostic methods requiring long processing times and potentially yielding false negatives, particularly after prior antibiotic exposure. We aimed to evaluate the feasibility and diagnostic accuracy of a bioelectrochemical method, based on electrochemical impedance spectroscopy (EIS), for the early detection of viable bacteria in periprosthetic fluid following implant-based reconstruction.
Methods:
A total of 47 patients undergoing immediate implant-based breast reconstruction were prospectively enrolled. Periprosthetic fluid samples were collected from the drainage tube at postoperative days 7 and/or 14 (107 samples in total). Each sample was analyzed using 3 diagnostic platforms: (1) EIS, (2) molecular diagnostics, and (3) conventional microbiology. The EIS signal (Z') was interpreted against a cut-off calibrated using gram-positive and gram-negative reference suspensions.
Results:
Infection was confirmed in 8 out of 47 patients (17.0%). EIS correctly identified all infected cases, showing full concordance with culture and molecular results. The technique distinguished gram-positive (Z' 6000-20,000 Ohms) from gram-negative infections (Z' 21,000-35,000 Ohms). The analytical time for EIS was approximately 9 min. Among positive patients, gram-positive infections were mostly asymptomatic or mild, whereas gram-negative infections were associated with severe clinical outcomes, including explantation.
Conclusion:
EIS offers a rapid, low-cost, and easy-to-use method for detecting bacterial presence in periprosthetic fluids. Unlike standard microbiological or molecular tests, it does not require bacterial growth, sample preparation, or nucleic acid extraction. With further validation, it has strong potential to support earlier, more tailored interventions.
Insights
A new bioelectrochemical method using electrochemical impedance spectroscopy (EIS) rapidly detects bacterial infections in breast reconstruction patients. This technique offers a faster, more accurate alternative to traditional methods for early infection diagnosis.
Area of Science:
- Biomedical Engineering
- Infectious Disease Diagnostics
- Surgical Oncology
Background:
- Postmastectomy implant-based breast reconstruction is susceptible to early postoperative infections.
- Current diagnostic methods are time-consuming and may produce false negatives, especially after antibiotic use.
- Early and accurate detection of bacterial periprosthetic fluid infections is crucial for effective treatment.
Purpose of the Study:
- To evaluate the feasibility and diagnostic accuracy of electrochemical impedance spectroscopy (EIS) for early bacterial detection in periprosthetic fluid.
- To assess EIS as a rapid, low-cost diagnostic tool for implant-based breast reconstruction infections.
- To compare EIS performance against conventional microbiology and molecular diagnostics.
Main Methods:
- Prospective enrollment of 47 patients undergoing immediate implant-based breast reconstruction.
- Collection of 107 periprosthetic fluid samples at postoperative days 7 and/or 14.
- Analysis of samples using EIS, molecular diagnostics, and conventional microbiology, with EIS interpreted against calibrated cut-offs.
Main Results:
- EIS demonstrated full concordance with culture and molecular results, correctly identifying all 8 infected cases (17.0% incidence).
- The technique differentiated gram-positive (Z' 6000-20,000 Ohms) from gram-negative infections (Z' 21,000-35,000 Ohms).
- EIS analytical time was approximately 9 minutes; gram-negative infections were linked to severe outcomes.
Conclusions:
- Electrochemical impedance spectroscopy (EIS) provides a rapid, cost-effective, and user-friendly method for detecting bacteria in periprosthetic fluids.
- EIS bypasses the need for bacterial growth, sample preparation, or nucleic acid extraction, unlike standard tests.
- Further validation of EIS holds significant potential for enabling earlier and more personalized interventions in breast reconstruction patients.
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