gms | German Medical Science

Infektiologie Update 2014: 24. Jahrestagung der Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG)

Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG)

16. - 18.10.2014, Weimar

Comparison between bacterial proof in sonication fluid and periprosthetic membranes in prosthetic hip and knee joint infection

Meeting Abstract

  • author Gunnar T. R. Hischebeth - Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
  • author Ernst Molitor - Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
  • author Dieter C. Wirtz - Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
  • author Achim Hoerauf - Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
  • author Sascha Gravius - Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
  • author Isabelle Bekeredjian-Ding - 6Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany

Infektiologie Update 2014. 24. Jahrestagung der Paul-Ehrlich-Gesellschaft für Chemotherapie (PEG). Weimar, 16.-18.10.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14peg35

doi: 10.3205/14peg35, urn:nbn:de:0183-14peg354

Veröffentlicht: 2. Oktober 2014

© 2014 Hischebeth et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Surgeries of the large joints, especially those of knee and hip joints with prosthetic replacements are among the most successful operations worldwide. Approximately 370,000 hip and knee joints are replaced in Germany per year (DRG Statistik 2012, Statistisches Bundesamt). One of the major complications in prosthetic joint surgery is septic loosening, e.g. infection of the replaced joint. Prosthetic joint infections lead to difficult, cost intensive treatment [1], functional deficits and long lasting hospitalization. Due to the demographic change the numbers of prosthetic joint arthoplasties will increase in the next decades and this will almost unavoidably be accompanied by an increase in the number of prosthetic joint infections.

In cases of suspected prosthetic joint infection microbiological and pathological diagnoses are the mainstay for treatment decisions. To date, the histopathological examination of periprosthetic membranes according to consensus classification of Morawietz and Krenn [2] is an important tool for the diagnosis of infections in joint replacements. Special emphasis is given to the occurrence of type 2 membranes that are typically seen in prosthetic joint infections and to type 3 membranes that combin the features of both wear particles and infection. Recently, sonication was implemented as a new diagnostic microbiological method in prosthetic joint infection. In periprosthetic knee and hip infection it was shown that sonication has a higher sensitivity than tissue cultures (78.5% versus 60.8%) [3].

In this study we evaluated the concordance between detection of bacteria in sonication fluid and the appearance of histological periprosthetic membranes type 2 and type 3 in 79 explanted prosthetic joint devices (47 prosthetic hip joints and 32 prosthetic knee joints). The foreign bodies were explanted due to aseptic loosening or suspicion of prosthetic joint infection. In 41 out of 79 prosthetic hip and knee joints proof of bacterial infection was achieved by sonication. 46 cases showed histopathological periprosthetic membranes classified as type 2 or type 3 membrane indicating an inflammatory process. Fisher’s exact testing showed that the correlation of positive bacterial culture following sonication and appearance of type 2 or type 3 membrane is statistically highly significant (p-value 0.0001).

In septic prosthetic joint surgery any proof of bacterial growth is a useful clue for the definition of the subsequent antibiotic and surgical treatment regime. With the implementation of sonication in foreign body associated infections we have gained an additional invaluable method that complements the histopathological examination of periprosthetic membranes. Additionally, our results show that there is a close correlation between these two methods in the verification of prosthetic joint infections.


References

1.
Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012 Sep;27(8 Suppl):61-5.e1. DOI: 10.1016/j.arth.2012.02.022 Externer Link
2.
Morawietz L, Classen RA, Schröder JH, Dynybil C, Perka C, Skwara A, Neidel J, Gehrke T, Frommelt L, Hansen T, Otto M, Barden B, Aigner T, Stiehl P, Schubert T, Meyer-Scholten C, König A, Ströbel P, Rader CP, Kirschner S, Lintner F, Rüther W, Bos I, Hendrich C, Kriegsmann J, Krenn V. Proposal for a histopathological consensus classification of the periprosthetic interface membrane. J Clin Pathol. 2006 Jun;59(6):591-7. DOI: 10.1136/jcp.2005.027458 Externer Link
3.
Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007 Aug;357(7):654-63. DOI: 10.1056/NEJMoa061588 Externer Link