Sonication has been increasingly used in the diagnosis of joint prosthesis infections. From 2013 to 2018 in the literature from the Proceedings of the International Consensus Meeting (ICM), sonication has been increasingly accepted by scholars and specialists. However, what is the best sonication fluid method for diagnosing PJI?
- Conventional microbiology?
- Blood culture bottles?
- Polymerase chain reaction?
- Gram’s staining?
- Microcalorimetry?
- Or any other method?
Depends on what your aim is? Culturing or diagnosis?
for diagnosis, PCR, Gram staining, microscopy can be definitely useful. However, except one example of yours, none of the others are culturing methods.
Thanks for your answer.
Gram-staining might not be a good way to diagnose PJI. Trampuz et al. found that the sensitivity and specificity of sonicate-fluid culture after Gram’s staining were 44.7% and 100.0%, respectively.
(Reference: Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357: 654–663.)
Do you mean what‘s the best medium for sonication? We put the implants in sterile container and use Ringers as fluid. I have also seen regular saline used as sonication fluid.
Cheng Li
Gram staining was yours suggestion, I did not say it is a good option. And Gram staining is not a diagnostic method at the first place. It is just a primary method for the classification of bacteria in two groups, which would give indication about the what would be the course of diagnosis and treatment.
Saeid Jokar
One meta-analysis of 9 sonication fluid PCR studies shows the sensitivity is 75% (95% confidence interval [CI], 0.71 to 0.81), and the specificity is 96 %(CI, 0.94 to 0.97). PCR of sonication fluid is a promising test for diagnosis of PJI, particularly in patients who previously received antibiotics.
- Badges
- Science method