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Nikolaev NS, Pchelova NN, Preobrazhenskaya EV, Nazarova VV, Dobrovol’skaya NY. “Unexpected” Infections in Revision Arthroplasty for Aseptic Loosening. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2021; 27:56-70. [DOI: 10.21823/2311-2905-2021-27-3-56-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background. Data from the national registers of arthroplasty showed that about 12% of hip and knee arthroplasty undergo revision within 10 years after the primary surgery. The leading cause of hip revisions is aseptic loosening of components, knee joint periprosthetic infection (PPI). Some of the infectious complications, including those related to mechanical causes, remain out of sight. The aim of the study was to identify the frequency of unexpected infections during revision knee and hip arthroplasty performed for aseptic complications of any etiology. Materials and Methods. 839 cases of revision arthroplasty of knee and hip joints were analyzed, including 485 aseptic revisions in 450 patients. Clinical, X-ray, laboratory (complete blood count and comprehensive metabolic panel, coagulation panel) methods, synovial fluid analysis and microbiological examination of punctures, including intraoperative ones, were used. The ICM and EBJIS (European Bone and Joint Infections Society) consensus recommendations were used as criteria for assessing the presence of infection. Results. The average age of patients at the time of the revision was 61.7 years. The hip joint prevailed (59.4%), knee joint 40.6%. The growth of microorganisms in the intraoperative biomaterial was detected in 2.08% of observations: in 10 out of 287 patients after aseptic revision of the hip joints and in none of the 198 revisions of the knee joints. In 8 out of 10 cases, the causative agents were coagulase-negative staphylococci, including 6 MRSE; in two cases, anaerobic bacteria. All revisions were carried out by a one-stage method. Patients with detected PPI underwent systemic antibacterial therapy. At the stage of catamnesis, reinfection was assumed in one of the 10 identified cases of PPI, the patient did not show up for revision. In control 63% of the group of the other (aseptic) 470 patients, PPI developed in 4 cases, two-stage revisions were carried out. Conclusions. The frequency of infections accidentally detected during aseptic revisions of large joints was 2.08%. Three-time examination of joint punctures, including intraoperative, provides additional opportunities for the diagnosis of PPI during aseptic revision, and also allows you to choose the optimal stage of revision treatment. The experience gained makes it possible in certain cases to perform one-stage revision in the treatment of PPI.
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Nikolaev NS, Pchelova NN, Preobrazhenskaya EV, Nazarova VV, Dobrovol’skaya NY. “Unexpected” Infections in Revision Arthroplasty for Aseptic Loosening. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2021; 27:56-70. [DOI: https:/doi.org/10.21823/2311-2905-2021-27-3-56-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Background. Data from the national registers of arthroplasty showed that about 12% of hip and knee arthroplasty undergo revision within 10 years after the primary surgery. The leading cause of hip revisions is aseptic loosening of components, knee joint periprosthetic infection (PPI). Some of the infectious complications, including those related to mechanical causes, remain out of sight. The aim of the study was to identify the frequency of unexpected infections during revision knee and hip arthroplasty performed for aseptic complications of any etiology. Materials and Methods. 839 cases of revision arthroplasty of knee and hip joints were analyzed, including 485 aseptic revisions in 450 patients. Clinical, X-ray, laboratory (complete blood count and comprehensive metabolic panel, coagulation panel) methods, synovial fluid analysis and microbiological examination of punctures, including intraoperative ones, were used. The ICM and EBJIS (European Bone and Joint Infections Society) consensus recommendations were used as criteria for assessing the presence of infection. Results. The average age of patients at the time of the revision was 61.7 years. The hip joint prevailed (59.4%), knee joint 40.6%. The growth of microorganisms in the intraoperative biomaterial was detected in 2.08% of observations: in 10 out of 287 patients after aseptic revision of the hip joints and in none of the 198 revisions of the knee joints. In 8 out of 10 cases, the causative agents were coagulase-negative staphylococci, including 6 MRSE; in two cases, anaerobic bacteria. All revisions were carried out by a one-stage method. Patients with detected PPI underwent systemic antibacterial therapy. At the stage of catamnesis, reinfection was assumed in one of the 10 identified cases of PPI, the patient did not show up for revision. In control 63% of the group of the other (aseptic) 470 patients, PPI developed in 4 cases, two-stage revisions were carried out. Conclusions. The frequency of infections accidentally detected during aseptic revisions of large joints was 2.08%. Three-time examination of joint punctures, including intraoperative, provides additional opportunities for the diagnosis of PPI during aseptic revision, and also allows you to choose the optimal stage of revision treatment. The experience gained makes it possible in certain cases to perform one-stage revision in the treatment of PPI.
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Macke C, Lenhof S, Graulich T, Örgel M, Omar-Pacha T, Stübig T, Krettek C, Omar M. Low Diagnostic Value of Synovial Aspiration Culture Prior to Reimplantation in Periprosthetic Joint Infection. In Vivo 2021; 35:2409-2416. [PMID: 34182524 DOI: 10.21873/invivo.12518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We aimed to determine the diagnostic value of the synovial aspiration culture prior to reimplantation in two- (or more) stage exchange of periprosthetic joint infection. PATIENTS AND METHODS This was a retrospective study, spanning over ten years including all synovial cultures of patients with two- (or more) stage exchange due to periprosthetic joint infection. RESULTS A total of 183 patients were included, mean age was 66.6 years (range=12.8-93.4 years). Overall sensitivity of synovial aspiration cultures before reimplantation was 56.6%, specificity 84.6%, negative predictive value (NPV) 63.8%, positive predictive value (PPV) 80.2%, area under the curve (AUC) 70.6%. Sensitivity of the knee in comparison to the hip culture was significantly higher, as well as the NPV and the AUC (p=0.038). In case of complete removal of prosthesis, the sensitivity and AUC were significantly reduced, whereas the specificity was comparable with prosthesis in situ, partial removal or complete removal. CONCLUSION Due to the low sensitivity, obtaining several synovial cultures in the prosthesis-free interval to exclude persistence of infection, does not seem reasonable.
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Affiliation(s)
- Christian Macke
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Stefan Lenhof
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Tilman Graulich
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Marcus Örgel
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Tarek Omar-Pacha
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Timo Stübig
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | | | - Mohamed Omar
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
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Ramczykowski T, Kruppa C, Schildhauer TA, Dudda M. Total hip arthroplasty following illicit drug abuse. Arch Orthop Trauma Surg 2018; 138:1353-1358. [PMID: 29922852 DOI: 10.1007/s00402-018-2980-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The role of illicit drug abuse in total joint arthroplasty is largely unknown and is likely underestimated. Patients with drug addictions often suffer from septic osteoarthritis or a necrosis of the femoral head. Purpose of the study was to evaluate the operative management and clinical outcome of total hip replacement in patients with a history of intravenous drug abuse. METHODS This retrospective study included 15 patients with a history of intravenous drug abuse who underwent total hip arthroplasty. A total of 6 females and 9 males with an average age of 34.3 years were identified. Ten patients presented an acute bacterial coxitis (Coxitis-group) and five an aseptic osteonecrosis of the femoral head (Osteonecrosis-group). RESULTS Ten patients with a bacterial coxitis underwent a two-staged total hip arthroplasty (THA), with temporary insertion of a drug-eluting spacer. Five patients with a necrosis of the femoral head were primarily treated with THA. All patients developed multiple re-infections after insertion of a drug-eluting spacer or THA. Only two patients finally achieved a THA without infection in the period of 3.9 years follow-up. The other 13 patients underwent a Girdlestone arthroplasty (7 patients) or total joint replacement with a chronic fistula (6 patients). CONCLUSION THA in patients with illicit drug abuse shows a low success rate. Following septic osteoarthritis or osteonecrosis in drug-addicted patients, we recommend a two-stage procedure with temporary insertion of a drug-eluting spacer. THA might follow only under strict premises.
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Affiliation(s)
- Tim Ramczykowski
- Department of General and Trauma Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Christiane Kruppa
- Department of General and Trauma Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, University Hospital Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Marcel Dudda
- Department of Trauma Surgery, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
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Janz V, Schoon J, Morgenstern C, Preininger B, Reinke S, Duda G, Breitbach A, Perka CF, Geissler S. Rapid detection of periprosthetic joint infection using a combination of 16s rDNA polymerase chain reaction and lateral flow immunoassay: A Pilot Study. Bone Joint Res 2018; 7:12-19. [PMID: 29305426 PMCID: PMC5805835 DOI: 10.1302/2046-3758.71.bjr-2017-0103.r2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES The objective of this study was to develop a test for the rapid (within 25 minutes) intraoperative detection of bacteria from synovial fluid to diagnose periprosthetic joint infection (PJI). METHODS The 16s rDNA test combines a polymerase chain reaction (PCR) for amplification of 16s rDNA with a lateral flow immunoassay in one fully automated system. The synovial fluid of 77 patients undergoing joint aspiration or primary or revision total hip or knee surgery was prospectively collected. The cohort was divided into a proof-of-principle cohort (n = 17) and a validation cohort (n = 60). Using the proof-of-principle cohort, an optimal cut-off for the discrimination between PJI and non-PJI samples was determined. PJI was defined as detection of the same bacterial species in a minimum of two microbiological samples, positive histology, and presence of a sinus tract or intra-articular pus. RESULTS The 16s rDNA test proved to be very robust and was able to provide a result in 97% of all samples within 25 minutes. The 16s rDNA test was able to diagnose PJI with a sensitivity of 87.5% and 82%, and a specificity of 100% and 89%, in the proof-of-principle and validation cohorts, respectively. The microbiological culture of synovial fluid achieved a sensitivity of 80% and a specificity of 93% in the validation cohort. CONCLUSION The 16s rDNA test offers reliable intraoperative detection of all bacterial species within 25 minutes with a sensitivity and specificity comparable with those of conventional microbiological culture of synovial fluid for the detection of PJI. The 16s rDNA test performance is independent of possible blood contamination, culture time and bacterial species.Cite this article: V. Janz, J. Schoon, C. Morgenstern, B. Preininger, S. Reinke, G. Duda, A. Breitbach, C. F. Perka, S. Geissler. Rapid detection of periprosthetic joint infection using a combination of 16s rDNA polymerase chain reaction and lateral flow immunoassay: A Pilot Study. Bone Joint Res 2018;7:12-19. DOI: 10.1302/2046-3758.71.BJR-2017-0103.R2.
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Affiliation(s)
- V Janz
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - J Schoon
- Julius Wolff Institute, BCRT & BSRT, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - C Morgenstern
- Center for Musculoskeletal Surgery, Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - B Preininger
- Center for Musculoskeletal Surgery, Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - S Reinke
- Julius Wolff Institute, BCRT & BSRT, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - G Duda
- Julius Wolff Institute, BCRT & BSRT, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - A Breitbach
- Institut für Pflanzenphysiologie, Martin-Luther-Universität Halle-Wittenberg, Weinbergweg 10, 06120 Halle, Germany
| | - C F Perka
- Center for Musculoskeletal Surgery, Julius Wolff Institute, BCRT & BSRT, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - S Geissler
- Julius Wolff Institute, BCRT & BSRT, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Hospach T, Hedrich C, Fernandez F, Girschick H, Borte M, Günther A, Martin L, Hahn G, von Kalle T, Horneff G, Kallinich T, Huppertz HI. Bakterielle Arthritis bei Kindern und Jugendlichen, Schwerpunkt Diagnostik. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0326-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Winkler T, Trampuz A, Renz N, Perka C, Bozhkova SA. CLASSIFICATION AND ALGORITHM FOR DIAGNOSIS AND TREATMENT OF HIP PROSTHETIC JOINT INFECTION. TRAVMATOLOGIYA I ORTOPEDIYA ROSSII 2016. [DOI: 10.21823/2311-2905-2016-0-1-33-45] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Winkler T, Trampuz A, Hardt S, Janz V, Kleber C, Perka C. Periprothetische Infektion nach Hüftendoprothetik. DER ORTHOPADE 2014; 43:70-8. [DOI: 10.1007/s00132-013-2132-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Haenle M, Zietz C, Lindner T, Arndt K, Vetter A, Mittelmeier W, Podbielski A, Bader R. A model of implant-associated infection in the tibial metaphysis of rats. ScientificWorldJournal 2013; 2013:481975. [PMID: 24381519 PMCID: PMC3871506 DOI: 10.1155/2013/481975] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 08/18/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Implant-associated infections remain serious complications in orthopaedic and trauma surgery. A main scientific focus has thus been drawn to the development of anti-infective implant coatings. Animal models of implant-associated infections are considered helpful in the in vivo testing of new anti-infective implant coatings. The aim of the present study was to evaluate a novel animal model for generation of implant-associated infections in the tibial metaphysis of rats. MATERIALS AND METHODS A custom-made conical implant made of Ti6Al4V was inserted bilaterally at the medial proximal tibia of 26 female Sprague-Dawley rats. Staphylococcus aureus in amounts spanning four orders of magnitude and each suspended in 15 μ l phosphate buffered saline (PBS) was inoculated into the inner cavity of the implant after the implantation into the defined position. Controls were treated accordingly with PBS alone. Animals were then followed for six weeks until sacrifice. Implant-associated infection was evaluated by microbiological investigation using swabs and determination of viable bacteria in the bone around the implant and the biofilm on the implants after sonification. RESULTS Irrespective of the initial inoculum, all animals in the various groups harbored viable bacteria in the intraoperative swabs as well as the sonication fluid of the implant and the bone samples. No correlation could be established between initially inoculated CFU and population sizes on implant surfaces at sacrifice. However, a significantly higher viable count was observed from peri-implant bone samples for animals inoculated with 10(6) CFU. Macroscopic signs of animal infection (pus and abscess formation) were only observed for implants inoculated with at least 10(5) CFU S. aureus. DISCUSSION/CONCLUSION The results demonstrate the feasibility of this novel animal model to induce an implant-associated infection in the metaphysis of rats, even with comparatively low bacterial inocula. The specific design of the implant allows an application of bacteria in reproducible numbers at well-defined contact sites to the animal bone.
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Affiliation(s)
- Maximilian Haenle
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany
| | - Carmen Zietz
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany
| | - Tobias Lindner
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany
| | - Kathleen Arndt
- Institute of Medical Microbiology, Virology and Hygiene, University Rostock, Schillingallee 70, 18057 Rostock, Germany
| | - Anika Vetter
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany
| | - Andreas Podbielski
- Institute of Medical Microbiology, Virology and Hygiene, University Rostock, Schillingallee 70, 18057 Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, University Medicine Rostock, Doberaner Straße 142, 18057 Rostock, Germany
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Evaluation of sonicate fluid cultures in comparison to histological analysis of the periprosthetic membrane for the detection of periprosthetic joint infection. INTERNATIONAL ORTHOPAEDICS 2013; 37:931-6. [PMID: 23525549 DOI: 10.1007/s00264-013-1853-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 02/22/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of this prospective study was to evaluate the diagnostic efficacy of sonicate fluid cultures (SFC) and the histological analysis of the periprosthetic membrane (PM) for the detection of periprosthetic joint infection (PJI). METHODS The histological samples were evaluated according to the consensus classification of PM as defined by Morawietz and Krenn. All explanted endoprosthesis were subject to sonication. Additionally, a synovial aspiration and microbiological culture of tissue samples were performed for each patient. Twenty three of the 59 patients had an established PJI. RESULTS Sonication achieved the highest sensitivity out of all diagnostic methods with 91 % and a specificity of 81 %. The PM achieved a sensitivity of 87 % and a specificity of 100 %. In three cases of PJI a pathogen was isolated solely by sonication while all other microbiological methods were negative. In seven cases there was a positive bacterial culture through sonication with negative histology. CONCLUSIONS Our results show a high correlation between the microbiological and histological results. In our patient group sonication achieved the highest sensitivity out of all diagnostic methods and was more sensitive than conventional microbiological methods.
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Abstract
Although it does offer certain obvious advantages, the one-staged revision approach in infected THA remains rare in the field of orthopaedics. Besides the reduced number of surgical interventions for patients, it is associated with a decreased inpatient hospital stay and quicker mobilisation. Furthermore, it might be the more cost-effective approach and enables a reduced duration of post-operative systemic antibiotics, usually less than 14 days in our setting. Technically speaking, the presence of a positive culture of a pre-operative aspiration and respective antibiogram are mandatory requirements. A general cemented implant fixation using topical antibiotics is the treatment of choice for single-staged procedures. The key to surgical success is based on the well-defined and detailed intra-hospital infrastructure, including a meticulous pre-operative hip aspiration regime, pre-operative planning and an aggressive intra-operative surgical approach.
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Gille J, Wallstabe S, Schulz AP, Paech A, Gerlach U. Is non-union of tibial shaft fractures due to nonculturable bacterial pathogens? A clinical investigation using PCR and culture techniques. J Orthop Surg Res 2012; 7:20. [PMID: 22607715 PMCID: PMC3489544 DOI: 10.1186/1749-799x-7-20] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 05/02/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-union continues to be one of the orthopedist's greatest challenges. Despite effective culture methods, the detection of low-grade infection in patients with non-union following tibial fracture still presents a challenge. We investigated whether "aseptic" tibial non-union can be the result of an unrecognized infection. METHODS A total of 23 patients with non-union following tibial shaft fractures without clinical signs of infection were investigated. Intraoperative biopsy samples obtained from the non-union site were examined by means of routine culture methods and by polymerase chain reaction (PCR) for the detection of 16 S ribosomal RNA (rRNA). Control subjects included 12 patients with tibial shaft fractures. RESULTS 23 patients (8 women and 15 men; mean age: 47.4 years) were included into this study. Preoperative C-reactive protein levels (mean: 20.8 mg/l) and WBC counts (mean: 8,359/μl) in the study group were not significantly higher than in the control group. None of the samples of non-union routine cultures yielded microorganism growth. Bacterial isolates were found by conventional culturing methods in only 1 case of an open fracture from the control group. In this case, PCR yielded negative results. 16 S rRNA was detected in tissue specimens from 2 patients (8.7%) with non-union. The analysis of these variable species-specific sequences enabled the identification of specific microorganisms (1x Methylobacterium species, 1x Staphylococcus species). Both PCR-positive patients were culture-negative. CONCLUSIONS The combination of microbiological culture and broad-range PCR seems to substantially add to the number of microbiological diagnoses obtained and may improve the clinician's ability to tailor therapy to the individual patient's needs.
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Affiliation(s)
- Justus Gille
- Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Campus Luebeck, Luebeck, 23538, Germany
| | - Steffen Wallstabe
- Department of Trauma Surgery and Sportsmedicine, BG-Traumahospital Hamburg, Hamburg, 21033, Germany
| | - Arndt-Peter Schulz
- Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Campus Luebeck, Luebeck, 23538, Germany
| | - Andreas Paech
- Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Campus Luebeck, Luebeck, 23538, Germany
| | - Ulf Gerlach
- Department of Trauma Surgery and Sportsmedicine, BG-Traumahospital Hamburg, Hamburg, 21033, Germany
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Schmitz HC, Schwantes B, Kendoff D. Einzeitiger Knieendoprothesenwechsel bei periprothetischer Infektion und Klippel-Trenaunay-Syndrom. DER ORTHOPADE 2011; 40:624-6, 628-9. [DOI: 10.1007/s00132-010-1732-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Frommelt L. Diagnostik und Therapie implantatassoziierter Infekte. DER ORTHOPADE 2009; 38:806-11. [DOI: 10.1007/s00132-009-1450-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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