Usefulness of Sonication in Implant-Related Infection

Jae Hyeon Seo; Mi Na Kim; Ji Wan Kim

doi:10.12671/jkfs.2020.33.2.81

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Original Article Usefulness of Sonication in Implant-Related Infection: Jae Hyeon Seo, Mi Na Kim, Ji Wan Kim; Journal of Musculoskeletal Trauma 2020;33(2):81-86.
DOI: https://doi.org/10.12671/jkfs.2020.33.2.81
Published online: April 30, 2020

¹Departments of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

²Departments of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

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Abstract

Purpose
This study determined whether the sonication of explants could improve the detection of bacteria and influence the optimal antibiotics treatment.
Materials and Methods
This retrospective study included the patients who underwent implant removal surgery followed by sonication culture as well as tissue culture in order to diagnose implant-related infection. A total of 37 consecutive patients with 41 cases were included. The patients’ demographic data, use of preoperative antibiotics, type of implants, change of antibiotics following the culture results, and recurrence of infection were all reviewed.
Results
Among 41 cases, 20 cases met the diagnostic requirements for implant-related infection as defined by musculoskeletal infection society criteria, while the other 21 cases had explant sonication to exclude indolent infection or residual infection. The latter showed negative results on the both explant cultures and tissue cultures. Among the 20 cases that met the requirements for implant-related infection, 19 cases (95.0%) were identified by any cultures. Of the 19 cases with positive culture results, 2 cases (10.5%) showed positive results only on sonication cultures, and one case (5.3%) showed positive results only on tissue culture. In 1 case of culture negative implant-related infection, a drain sinus was present preoperatively, but the cultures were negative according to both methods. The culture results made postoperative antibiotics change in 12 cases among the 19 culture (+) cases. Antibiotics changes were based on the tissue culture in 2 cases, 2 cases were based on the sonication culture, and the remaining 8 cases were based on both cultures.
Conclusion
The sonication culture improved the diagnosis of implant-related infection combined with conventional tissue culture and helped to determine administering the proper antibiotics.

Keywords: Infection, Implant-related infection, Biofilm, Sonication

J Korean Fract Soc. 2020 Apr;33(2):81-86. Korean.
Published online Apr 28, 2020.
https://doi.org/10.12671/jkfs.2020.33.2.81

Original Article

Usefulness of Sonication in Implant-Related Infection

Jae Hyeon Seo

, M.D., Mi Na Kim

, M.D., Ph.D.,^* and Ji Wan Kim

, M.D., Ph.D.

Author information

Author notes

- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- ^*Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Correspondence to: Ji Wan Kim, M.D., Ph.D. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympicro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3530, Fax: +82-2-488-7877, Email: bakpaker@hanmail.net

Received March 05, 2020; Revised March 17, 2020; Accepted March 26, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study determined whether the sonication of explants could improve the detection of bacteria and influence the optimal antibiotics treatment.

Materials and Methods

This retrospective study included the patients who underwent implant removal surgery followed by sonication culture as well as tissue culture in order to diagnose implant-related infection. A total of 37 consecutive patients with 41 cases were included. The patients' demographic data, use of preoperative antibiotics, type of implants, change of antibiotics following the culture results, and recurrence of infection were all reviewed.

Results

Among 41 cases, 20 cases met the diagnostic requirements for implant-related infection as defined by musculoskeletal infection society criteria, while the other 21 cases had explant sonication to exclude indolent infection or residual infection. The latter showed negative results on the both explant cultures and tissue cultures. Among the 20 cases that met the requirements for implant-related infection, 19 cases (95.0%) were identified by any cultures. Of the 19 cases with positive culture results, 2 cases (10.5%) showed positive results only on sonication cultures, and one case (5.3%) showed positive results only on tissue culture. In 1 case of culture negative implant-related infection, a drain sinus was present preoperatively, but the cultures were negative according to both methods. The culture results made postoperative antibiotics change in 12 cases among the 19 culture (+) cases. Antibiotics changes were based on the tissue culture in 2 cases, 2 cases were based on the sonication culture, and the remaining 8 cases were based on both cultures.

Conclusion

The sonication culture improved the diagnosis of implant-related infection combined with conventional tissue culture and helped to determine administering the proper antibiotics.

Keywords

Infection, Implant-related infection, Biofilm, Sonication

Figures

Fig. 1
An example of sterile containers for the removed implants. To minimize contamination, we sealed the container with sterile surgical drape.

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Fig. 2
Flowchart of the enrolled participants and the results of culture.

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Tables

Table 1
Implants Type

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Table 2
Profile of the Microorganisms

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Notes

Financial support:None.

Conflict of interests:None.

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Usefulness of Sonication in Implant-Related Infection

J Korean Fract Soc. 2020;33(2):81-86. Published online April 30, 2020

DOI: https://doi.org/10.12671/jkfs.2020.33.2.81