TY - JOUR
T1 - Implant Sonication versus Tissue Culture for the Diagnosis of Spinal Implant Infection
AU - Carlson, Bayard C.
AU - Hines, Jeremy T.
AU - Robinson, William A.
AU - Sebastian, Arjun S.
AU - Greenwood-Quaintance, Kerryl E.
AU - Patel, Robin
AU - Huddleston, Paul M.
N1 - Funding Information:
From the *Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; †Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; and zDivision of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN. Acknowledgment date: May 23, 2019. First revision date: August 14, 2019. Acceptance date: October 1, 2019. The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication. The National Institutes of Health (award number R01AR056647) funds were received in support of this work. No relevant financial activities outside the submitted work. Address correspondence and reprint requests to Paul M. Huddleston, MD, Department of Orthopedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905; E-mail: Huddleston.paul@mayo.edu
Publisher Copyright:
© Copyright 2020 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Study Design.This is a retrospective study comparing the diagnosis of spinal implant infection (SII) by peri-implant tissue culture to vortexing-sonication of retrieved spinal implants.Objective.We hypothesized that vortexing-sonication would be more sensitive than peri-implant tissue culture.Summary of Background Data.We previously showed implant vortexing-sonication followed by culture to be more sensitive than standard peri-implant tissue culture for diagnosing of SII. In this follow-up study, we analyzed the largest sample size available in the literature to compare these two culture methods and evaluated thresholds for positivity for sonicate fluid for SII diagnosis.Methods.We compared peri-implant tissue culture to the vortexing-sonication technique which samples bacterial biofilm on the surface of retrieved spinal implants. We evaluated different thresholds for sonicate fluid positivity and assessed the sensitivity and specificity of the two culture methods for the diagnosis of SII.Results.A total of 152 patients were studied. With more than 100 colony forming units (CFU)/10 mL as a threshold for sonicate fluid culture positivity, there were 46 patients with SII. The sensitivities of peri-implant tissue and sonicate fluid culture were 65.2% and 79.6%; the specificities were 88.7% and 93.4%, respectively. With more than 50 CFU/10 mL as a threshold, there were 50 patients with SII. The sensitivities of peri-implant tissue and sonicate fluid culture were 68.0% and 76.0%; the specificities were 92.2% for both methods. Finally, with more than or equal to 20 CFU/10 mL as a threshold, there were 52 patients with SII. The sensitivities of peri-implant tissue and sonicate fluid culture were 69.2% and 82.7%; the specificities were 94.0% and 92.0%, respectively.Conclusion.Implant sonication followed by culture is a sensitive and specific method for the diagnosis of SII. Lower thresholds for defining sonicate fluid culture positivity allow for increased sensitivity with a minimal decrease in specificity, enhancing the clinical utility of implant sonication.Level of Evidence: 4.
AB - Study Design.This is a retrospective study comparing the diagnosis of spinal implant infection (SII) by peri-implant tissue culture to vortexing-sonication of retrieved spinal implants.Objective.We hypothesized that vortexing-sonication would be more sensitive than peri-implant tissue culture.Summary of Background Data.We previously showed implant vortexing-sonication followed by culture to be more sensitive than standard peri-implant tissue culture for diagnosing of SII. In this follow-up study, we analyzed the largest sample size available in the literature to compare these two culture methods and evaluated thresholds for positivity for sonicate fluid for SII diagnosis.Methods.We compared peri-implant tissue culture to the vortexing-sonication technique which samples bacterial biofilm on the surface of retrieved spinal implants. We evaluated different thresholds for sonicate fluid positivity and assessed the sensitivity and specificity of the two culture methods for the diagnosis of SII.Results.A total of 152 patients were studied. With more than 100 colony forming units (CFU)/10 mL as a threshold for sonicate fluid culture positivity, there were 46 patients with SII. The sensitivities of peri-implant tissue and sonicate fluid culture were 65.2% and 79.6%; the specificities were 88.7% and 93.4%, respectively. With more than 50 CFU/10 mL as a threshold, there were 50 patients with SII. The sensitivities of peri-implant tissue and sonicate fluid culture were 68.0% and 76.0%; the specificities were 92.2% for both methods. Finally, with more than or equal to 20 CFU/10 mL as a threshold, there were 52 patients with SII. The sensitivities of peri-implant tissue and sonicate fluid culture were 69.2% and 82.7%; the specificities were 94.0% and 92.0%, respectively.Conclusion.Implant sonication followed by culture is a sensitive and specific method for the diagnosis of SII. Lower thresholds for defining sonicate fluid culture positivity allow for increased sensitivity with a minimal decrease in specificity, enhancing the clinical utility of implant sonication.Level of Evidence: 4.
KW - implant sonification
KW - spinal implant infection
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U2 - 10.1097/BRS.0000000000003311
DO - 10.1097/BRS.0000000000003311
M3 - Article
C2 - 32282655
AN - SCOPUS:85083419078
SN - 0362-2436
VL - 45
SP - E525-E532
JO - Spine
JF - Spine
IS - 9
ER -