The utility of dithiothreitol treatment of periprosthetic tissues and explanted implants in the diagnosis of prosthetic joint infection |
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| Institution: | 1. Department of Microbiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India;2. Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India;3. Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), New Delhi, India;1. Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India;2. Hospital Infection Control Committee, Christian Medical College, Vellore, Tamil Nadu, India;3. Department of Geriatrics, Christian Medical College, Vellore, Tamil Nadu, India;1. Department of Microbiology, Pramukhswami Medical College, Karamsad, 388325, Gujarat, India;2. Department of Microbiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research Deemed to Be University, Belagavi, Karnataka, 590010, India;1. Department of Microbiology, Institute of Post-Graduate Medical Education & Research, 244 AJC Bose Road, Kolkata, 700020, India;2. Department of Dermatology, Institute of Post-Graduate Medical Education & Research, 244 AJC Bose Road, Kolkata, 700020, India;1. Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India;2. Department of Hospital Operations, Institute of Liver and Biliary Sciences, New Delhi, India;3. Department of Research, Institute of Liver and Biliary Sciences, New Delhi, India;4. Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India;1. Department of Medicine, JIPMER, India;2. Department of Microbiology, JIPMER, India;1. Kastamonu Research and Training Hospital, Department of Medical Microbiology, Kastamonu, Turkey;2. Ege University Faculty of Medicine, Department of Medical Microbiology, İzmir, Turkey |
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| Abstract: | PurposeThe methods used for the processing of periprosthetic tissues and explanted implants to improve culture outcome especially in biofilm mediated prosthetic joint infections (PJIs) are still debated upon. Studies have reported that Dithiothreitol (DTT) pretreatment of infected devices gives similar results as sonication. However, none of them evaluated the DTT treatment of periprosthetic tissues and explanted implants in the same cohort. We evaluated the diagnostic utility of DTT treatment of periprosthetic tissue and explanted implants, as compared to the normal saline treatment of periprosthetic tissues and sonication of explanted implants for the diagnosis of PJI.MethodsSeventy-three revision arthroplasty cases were prospectively included in this study. Three to five tissue specimens and the explanted implants were collected from each patient. Periprosthetic tissue samples were processed by both normal saline and DTT treatments. Explanted implants were subjected to both DTT treatment and sonication. Musculoskeletal Infection Society (MSIS) PJI criteria was used as the reference standard for the diagnosis of PJI.ResultsOf the 73 cases enrolled, 34 had PJI and 39 were aseptic failures. The sensitivity of DTT treated periprosthetic tissue culture (PTC) and saline treated PTC was similar (66.6% vs 58.8%, P = 0.25). The specificity of both was 100%. Sonication and DTT treatment of explanted implants showed comparable sensitivity (85.3% vs 82.4%) and specificity (100% vs 97.4%), P > 0.99. Compared to DTT treated PTC, culture of DTT treated explanted implants significantly improved the diagnosis of PJI (P = 0.03).ConclusionsWe could verify that DTT can be used to improve culture outcome in laboratories where biofilm detaching sonication techniques are not available for infected implants. In addition, we showed that it is possible to use DTT for treating tissue biopsies, but larger studies are required to confirm our findings. |
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| Keywords: | Aseptic failure Biofilm Dithiothreitol Prosthetic joint infection Sonication |
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