Palmer, J Orthop Trauma 2014 - Can We Trust Intraoperative Culture Results in Nonunions?

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Can We Trust Intraoperative Culture Results in Nonunions?

Palmer, Costerton, et al.·J Orthop Trauma·2014·80 citations·Prospective cohort

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Purpose

To identify the presence of bacterial biofilms in nonunions comparing molecular techniques (multiplex polymerase chain reaction and mass spectrometry, fluorescent in situ hybridization) with routine intraoperative cultures.

Methods

34 patients with nonunions were scheduled for surgery and enrolled in this ongoing prospective study.
Intraoperative specimens were collected from removed implants, surrounding tissue membrane, and local soft tissue followed by standard culture analysis, Ibis's second generation molecular diagnostics (Ibis Biosystems), and bacterial 16S rRNA-based fluorescence in situ hybridization (FISH).
Confocal microscopy was used to visualize the tissue specimens reacted with the FISH probes, which were chosen based on the Ibis analysis.

Results

34 patient encounters were analyzed.
8 were diagnosed as infected nonunions by positive intraoperative culture results.
Ibis confirmed the presence of bacteria in all 8 samples.
Ibis identified bacteria in a total of 30 of 34 encounters, and these data were confirmed by FISH.
22 of 30 Ibis-positive samples were culture-negative.
4 samples were negative by all methods of analysis.
No samples were positive by culture, but negative by molecular techniques.

Conclusions

Our preliminary data indicate that molecular diagnostics are more sensitive for identifying bacteria than cultures in cases of bony nonunion. This is likely because of the inability of cultures to detect biofilms and bacteria previously exposed to antibiotic therapy.

Level of evidence: Diagnostic Level I. Copyright remains with the authors and publisher.

Can We Trust Intraoperative Culture Results in Nonunions?

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Can We Trust Intraoperative Culture Results in Nonunions?

Palmer, Costerton, et al.·J Orthop Trauma·2014·80 citations·Prospective cohort

|

Purpose

To identify the presence of bacterial biofilms in nonunions comparing molecular techniques (multiplex polymerase chain reaction and mass spectrometry, fluorescent in situ hybridization) with routine intraoperative cultures.

Methods

34 patients with nonunions were scheduled for surgery and enrolled in this ongoing prospective study.
Intraoperative specimens were collected from removed implants, surrounding tissue membrane, and local soft tissue followed by standard culture analysis, Ibis's second generation molecular diagnostics (Ibis Biosystems), and bacterial 16S rRNA-based fluorescence in situ hybridization (FISH).
Confocal microscopy was used to visualize the tissue specimens reacted with the FISH probes, which were chosen based on the Ibis analysis.

Results

34 patient encounters were analyzed.
8 were diagnosed as infected nonunions by positive intraoperative culture results.
Ibis confirmed the presence of bacteria in all 8 samples.
Ibis identified bacteria in a total of 30 of 34 encounters, and these data were confirmed by FISH.
22 of 30 Ibis-positive samples were culture-negative.
4 samples were negative by all methods of analysis.
No samples were positive by culture, but negative by molecular techniques.

Conclusions

Our preliminary data indicate that molecular diagnostics are more sensitive for identifying bacteria than cultures in cases of bony nonunion. This is likely because of the inability of cultures to detect biofilms and bacteria previously exposed to antibiotic therapy.

Level of evidence: Diagnostic Level I. Copyright remains with the authors and publisher.

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