Are antibiotic impregnated cement spacers safe in the treatment of two-stage orthopaedic revision surgery?
Abstract number: P1450
Sorlí M.L., Torres R., Puig L., Gonzalez A., Alier A., Montero M., Villar J., Knobel H., Horcajada J.P.
Background: In two-stage orthopedic revision surgery, the use of antibiotic-impregnated cement spacer is a common procedure. We hypothesized that culturing of samples obtained from the cement spacers would improve the microbiological diagnosis of subclinical prosthetic joint infections.
Methods: Prospective cohort study. Patients undergoing a second-stage orthopedic revision surgery from January 2007 to July 2008 were prospectively included. Before second-stage surgery patients received 6 weeks of guided antimicrobial therapy and had an antibiotic free period of 3.2 weeks (4.1 SD). Periprosthetic tissue (PT) specimens (5) were collected for culture. Removed spacers were sonicated during 5 min. (40Hz). Both PT and sonicate-fluid (SF), were inoculated in aerobic agar (Chocolate Polyvitex), anaerobic agar (Schaedler + 5% blood) and in thioglycolat for 7 days. Cut-off positive culture was defined as growing of >5 CFU on either plate. Subclinical prosthetic joint infection (SPJI) was defined as having at least one positive culture. All patients with SPJI diagnosis were treated with guided antibiotic therapy. Microorganisms isolated were assessed and compared with those isolated in the first-stage surgery. Clinical status was evaluated after a median follow-up of 44 weeks. Clinical failure was defined when purulence in the synovial fluid or implant site, sinus tract and/or clinical signs of acute inflammation were present.
Results: 55 patients were included (37 knee, 17 hip, 1 shoulder). 3 patients dropped from follow up. 10 (19.2%) SPJI were detected. Clinical failure was found in 17 (32.7%) patients. 70% of these were patients previously diagnosed of SPJI (7 out of 10), and 23.8% were patients with negative cultures (10 out of 42). pf-0.009.
Conclusions: (1) Positive cultures of sonicated spacers or PTs (SPJI) were found in 19.2% of patients undergoing a second-stage orthopedic revision surgery. (2) SPJI is associated with a poor clinical outcome. (3) Periprosthetic tissue cultures and sonication should be done in order to rule out SPJI.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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