The Performance of a Dithiothreitol-Based Diagnostic System in Diagnosing Periprosthetic Joint Infection Compared to Sonication Fluid Cultures and Tissue Biopsies

Abstract

Purpose The aim of this study was to evaluate the performance of a commercially available dithiothreitol (DTT) kit for routine use in diagnosing periprosthetic joint infections (PJIs) in comparison to conventional microbiological tissue specimens and sonication procedures in a maximal care hospital.

Methods We applied the DTT system in 40 consecutive cases of revision arthroplasty (23 PJIs and 17 aseptic revisions), with an exchange or a removal of components. The hardware components were split between the DTT system and the conventional sonication procedure. At least three tissue biopsies and a joint fluid specimen were sent for microbiological and histopathological analysis. Data was analysed retrospectively to compare between the different methods.

Results Cultures of the DTT fluid showed a sensitivity of 65% and specificity of 100%, as referenced to conventional microbiological cultures. Sonication had better sensitivity (75%) but lower specificity (85%). The categorical agreement of DTT cultures compared to sonication fluid cultures was 78% (31/40). Neither pathogen type, infection duration nor antibiotic pretreatment influenced the accuracy of the DTT, but a low pH in the DTT seemed to be associated with false-negative results.

Conclusion DTT was inferior in sensitivity when diagnosing PJIs compared to sonication fluid cultures and tissue biopsies. A low pH in the DTT fluid correlated with false-negative results. Nevertheless, the closed system of the DTT kit avoids contamination and false-positive results, and DTT can be an alternative where sonication is not available.

Zusammenfassung

Ziel Das Ziel dieser Studie war die Bewertung eines kommerziell verfügbaren Diagnostik-Kits, welches durch den Einsatz von Dithiothreitol (DTT) in einem Doppelkammerbeutel den Biofilm von Explantaten bei periprothetischen Infektionen (PJI) lösen und der mikrobiologischen Diagnostik zugänglich machen soll. Die Ergebnisse des DTT-Systems wurden gegen konventionelle Mikrobiologie und klassische Sonikation getestet und bewertet.

Methoden Das System wurde gemäß seiner Zulassung bei insg. 40 konsekutiven Prothesenrevisions-Fällen eingesetzt (23 mit PJI, 17 mit aseptischer Revisionsursache), wenn ein Wechsel der Prothese oder einzelner Komponenten vorgenommen wurde. Die Explantate wurden auf konventionelle Sonikation und das DTT-System verteilt. Das Gelenkpunktat, sowie mindestens 3 Gewebeproben wurden in jedem Fall mikrobiologisch und histologisch untersucht. Die Datenanalyse und Auswertung erfolgte retrospektiv.

Ergebnis Die Kultur aus der DTT-Flüssigkeit zeigte seine Sensitivität von 65% und Spezifität von 100% zur Detektion eines periprothetischen Infektes, bezogen auf die Ergebnisse der konventionellen Mikrobiologie. Die normale Sonikation hatte mit 75% eine höhere Sensitivität, aber dafür schlechtere Spezifität (85%). DTT und Sonikation stimmten in 78% der Fälle (31/40) im Bezug auf den Keimnachweis überein. Weder beeinflussten bestimmte Erreger, noch die Infektdauer oder eine antibiotische Vorbehandlung die Genauigkeit des DTT-Testes. Ein niedriger pH-Wert im DTT schien mit falsch-negativen Ergebnissen assoziiert.

Schlussfolgerung Das DTT-Kit zeigte eine schlechtere Sensitivität als Sonikation und konventionelle Gewebeproben. Ein niedriger pH-Wert im DTT scheint mit falsch-negativen Proben assoziiert sein. Trotzdem bietet das in sich geschlossene und CE-zertifizierte System eine mögliche Alternative zur Untersuchung von explantiertem Material, wenn die Sonikation nicht eingesetzt werden kann.

Key words

septic arthritis - periprosthetic joint infection - sonication - revision arthroplasty - biofilm

Schlüsselwörter

septische Arthritis - periprothetische Infektion - Sonikation - Revisionsendoprothetik - Biofilm

Publication History

Article published online:
11 May 2020

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