How many samples and how many culture media to diagnose a Prosthetic Joint Infection: A clinical and microbiological prospective multicenter study

Abstract : BACKGROUND: Although numerous perioperative samples and culture media are required to diagnose prosthetic joint infection (PJI), their exact number and types have not yet been definitely determined with a high level of proof. OBJECTIVES: We conducted a prospective multicenter study to determine the minimal number of samples and culture media required for accurate diagnosis of PJI. METHODS: Over a 2-year period, consecutive patients with clinical signs suggesting PJI were included, with 5 perioperative samples per patient. The bacteriological and PJI diagnosis criteria were assessed using a random selection of 2, 3 or 4 samples, and compared with those obtained using the 5 recommended samples (references guidelines. The results obtained with 2 or 3 culture media were then compared with those obtained with 5 culture media for both criteria. The times-to-positivity of the different culture media were calculated. RESULTS: PJI was confirmed in 215/264 suspected cases, with a bacteriological criterion in 192 (89%). The PJI was monomicrobial (85%) or polymicrobial (15%). Percentages of agreement of 98.1% and 99.7% respectively for the bacteriological criterion and confirmed PJI diagnosis were obtained when 4 perioperative samples were considered. The highest percentages of agreement were obtained with the association of 3 culture media, a blood culture bottle, a chocolate agar plate and Schaedler broth, incubated for 5, 7 and 14 days respectively. This new procedure would lead to significant cost saving. CONCLUSION: Our prospective multicenter study showed that 4 samples seeded on 3 culture media are sufficient for diagnosing PJI
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Journal of Clinical Microbiology, American Society for Microbiology, 2016, 54 (2), pp. 385-391 〈10.1128/JCM.02497-15〉
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Pascale Bémer, Julie Leger, Didier Tandé, Chloé Plouzeau, Anne Sophie Valentin, et al.. How many samples and how many culture media to diagnose a Prosthetic Joint Infection: A clinical and microbiological prospective multicenter study. Journal of Clinical Microbiology, American Society for Microbiology, 2016, 54 (2), pp. 385-391 〈10.1128/JCM.02497-15〉. 〈hal-01255868〉

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