Download PDF
CC BY-NC-ND 4.0 · J Lab Physicians 2021; 13(03): 224-230
DOI: 10.1055/s-0041-1730879
Original Article

A Prospective Study to Assess the Optimal Incubation Times for Culture and Aerobic Bacterial Profile in Prosthetic Joint Infections

Varsha Gupta
1   Department of Microbiology, Government Medical College Hospital, Chandigarh, Punjab, India
,
Mandeep Kaur 
2   Department of Microbiology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
,
Prapti Bora
1   Department of Microbiology, Government Medical College Hospital, Chandigarh, Punjab, India
,
Pooja Kumari
1   Department of Microbiology, Government Medical College Hospital, Chandigarh, Punjab, India
,
Priya Datta
3   Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
,
Ravi Gupta
4   Department of Orthopedics, Government Medical College Hospital, Chandigarh, Punjab, India
,
Jagdish Chander
1   Department of Microbiology, Government Medical College Hospital, Chandigarh, Punjab, India
› Author Affiliations Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction With an increase in the number of total joint arthroplasties, the count of prosthetic joint infections (PJIs) is also increasing and has become a nightmare for an orthopaedic surgeon. Microbiological diagnosis is important for administering definitive antimicrobial treatment. Negative culture reports hamper patient management and prolonged incubation periods have increased the culture yield but at the risk of culture contamination in conventional microbiology settings. Thus, we aimed to optimize the best incubation time for culture and the aerobic bacterial profile of PJIs.

Material and Methods Over a year, samples from clinically suspected PJI patients were collected and processed for culture using standard techniques. The samples were incubated for up to 10 days with daily subculturing on to solid media. The bacterial isolates were identified and antibiotic susceptibility was performed.

Results Out of 200 patients, 105 were included in the study and samples were collected in triplicate. In 70 cases culture was positive and 35 were culture negative PJIs. Mean incubation days to culture positivity was 3.6 days with 97.14% culture positivity seen by the seventh day of incubation. Twenty-four percent methicillin-resistant Staphylococcus aureus, and more than 50% extended spectrum β lactamase producing Klebsiella pneumoniae and Escherichia coli were isolated.

Discussion Culture positivity in PJIs provides definitive evidence of infection and guides the treatment. Increasing the incubation times can help in maximizing the culture yield, and we found that 97.14% pathogens grew within 7 days of incubation. Prolonging it further would not provide an added advantage especially in a resource-constraint setting.

Keywords

prosthesis - infections - culture - prolonged incubation - Staphylococcus aureus


Publication History

Article published online:
06 July 2021

© 2021. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Sebastian S, Malhotra R, Dhawan B. Prosthetic joint infection: a major threat to successful total joint arthroplasty. Indian J Med Microbiol 2018; 36 (04) 475-487
    CrossrefPubMedGoogle Scholar
  • 2 Larsen LH, Lange J, Xu Y, Schønheyder HC. Optimizing culture methods for diagnosis of prosthetic joint infections: a summary of modifications and improvements reported since 1995. J Med Microbiol 2012; 61 (Pt 3) 309-316
    CrossrefPubMedGoogle Scholar
  • 3 Koh IJ, Cho W-S, Choi NY, Parvizi J, Kim TK. Korea Knee Research Group. How accurate are orthopedic surgeons in diagnosing periprosthetic joint infection after total knee arthroplasty? A multicenter study. Knee 2015; 22 (03) 180-185
    CrossrefPubMedGoogle Scholar
  • 4 Parvizi J, Tan TL, Goswami K. et al The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 2018; 33 (05) 1309-1314.e2
    CrossrefPubMedGoogle Scholar
  • 5 Schäfer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis 2008; 47 (11) 1403-1409
    CrossrefPubMedGoogle Scholar
  • 6 Schwotzer N, Wahl P, Fracheboud D, Gautier E, Chuard C. Optimal culture incubation time in orthopedic device-associated infections: a retrospective analysis of prolonged 14-day incubation. J Clin Microbiol 2014; 52 (01) 61-66
    CrossrefPubMedGoogle Scholar
  • 7 Osmon DR, Berbari EF, Berendt AR. et al Infectious Diseases Society of America. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013; 56 (01) e1-e25
    CrossrefPubMedGoogle Scholar
  • 8 Miller JM, Binnicker MJ, Campbell S. et al A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis 2018; 67 (06) e1-e94
    CrossrefPubMedGoogle Scholar
  • 9 Collee JG, Miles RS, Watt B. Tests for the identification of bacteria. In: Collee JG, Fraser AG, Marmion BP, Simmon A, eds. Mackie and McCartney Practical Medical Microbiology. 14th ed. Edinburgh: Churchill Livingstone 2006: 131-150
  • 10 CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 27th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2017
  • 11 Vaishya R, Sardana R, Butta H, Mendiratta L. Laboratory diagnosis of prosthetic joint infections: current concepts and present status. J Clin Orthop Trauma 2019; 10 (03) 560-565
    CrossrefPubMedGoogle Scholar
  • 12 Tan TL, Kheir MM, Shohat N, Tan DD, Kheir M, Chen C. et al. Culture-negative periprosthetic joint infection—an update on what to expect. JBJS Open Access 2018; 3 (03) e0060
    CrossrefPubMedGoogle Scholar
  • 13 Sebastian S, Malhotra R, Sreenivas V, Kapil A, Chaudhry R, Dhawan B. A clinico-microbiological study of prosthetic joint infections in an Indian tertiary care hospital: role of universal 16S rRNA gene polymerase chain reaction and sequencing in diagnosis. Indian J Orthop 2019; 53 (05) 646-654
    CrossrefPubMedGoogle Scholar
  • 14 Costales C, Butler-Wu SM. A real pain: diagnostic quandaries and septic arthritis. J Clin Microbiol 2018; 56 (02) e01358-e01317
    CrossrefPubMedGoogle Scholar
  • 15 Gunthard H, Hany A, Turina M, Wust J.. Propionibacterium acnes as a cause of aggressive aortic valve endocarditis and importance of tissue grinding: case report and review. J Clin Microbiol 1994; 32: 3043-3045
    CrossrefPubMedGoogle Scholar
  • 16 Butler-Wu SM, Burns EM, Pottinger PS, Magaret AS, Rakeman JL, Matsen FA. et al. Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection. J Clin Microbiol 2011; 49: 2490-2495
    CrossrefPubMedGoogle Scholar
  • 17 Hujazi I, Oni D, Arora A, Muniz G, Khanduja V. The fate of acutely inflamed joints with a negative synovial fluid culture. Int Orthop 2012; 36 (07) 1487-1492
    CrossrefPubMedGoogle Scholar
  • 18 Lalremruata R. Prosthetic joint infection: a microbiological review. J Med Soc 2015; 29: 120-128
    CrossrefGoogle Scholar
  • 19 Esposito S, Leone S. Prosthetic joint infections: microbiology, diagnosis, management and prevention. Int J Antimicrob Agents 2008; 32 (04) 287-293
    CrossrefPubMedGoogle Scholar
  • 20 Salgado CD, Dash S, Cantey JR, Marculescu CE.. Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res 2007; 461: 48-53
    CrossrefPubMedGoogle Scholar
  • 21 Peel TN, Cheng AC, Buising KL, Choong PF. Microbiological aetiology, epidemiology, and clinical profile of prosthetic joint infections: are current antibiotic prophylaxis guidelines effective?. Antimicrob Agents Chemother 2012; 56 (05) 2386-2391
    CrossrefPubMedGoogle Scholar