Sonication of antibiotic spacers predicts failure during two-stage revision for prosthetic knee and hip infections.
Clin Orthop Relat Res
; 472(7): 2208-14, 2014 Jul.
Article
em En
| MEDLINE
| ID: mdl-24658903
ABSTRACT
BACKGROUND:
Periprosthetic joint infection is a leading cause of failure after two-stage reimplantation. One cause of relapse may be persistent subclinical infection. Difficulty exists in detecting biofilm-forming infections. Sonication disrupts biofilm and has led to higher rates of positive intraoperative cultures. QUESTIONS/PURPOSES:
Our aims in this study were to determine (1) if sonication results were predictive of failure, including reinfection, at 2-year followup; and (2) whether sonication of antibiotic spacers at the time of reimplantation improves sensitivity of intraoperative cultures.METHODS:
We prospectively followed 36 consecutive patients undergoing two-stage reimplantation for periprosthetic hip or knee infection. Minimum followup was 19 months (mean, 29.9 months; range, 1938 months). Results of intraoperative cultures and sonicated antibiotic spacers were analyzed.RESULTS:
Positive sonication results were predictive of failure as defined by reinfection at 2-year followup. Among the 18 patients who had positive sonication results, reinfection developed in nine patients (50%) compared with two of 18 patients (11%) with negative sonication results (odds ratio, 8.0; 95% CI, 1.269.0). Sonication of antibiotic spacers improved the sensitivity of intraoperative cultures from 45% to 82%. [corrected].CONCLUSIONS:
Sonication of antibiotic spacers appears to be useful in predicting failure attributable to recurrent infection after two-stage reimplantation. For patients with positive sonication cultures during reimplantation, more aggressive antimicrobial treatment may be indicated after reimplantation. LEVEL OF EVIDENCE Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Base de dados:
MEDLINE
Assunto principal:
Sonicação
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Cimentos Ósseos
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Infecções Relacionadas à Prótese
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Artroplastia de Quadril
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Artroplastia do Joelho
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Prótese de Quadril
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Prótese do Joelho
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Antibacterianos
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article