超声裂解液培养在关节假体周围感染诊断中的应用

Application of sonication fluid culture in diagnosing periprosthetic joint infection

目的观察超声裂解液培养在关节假体周围感染(PJI)诊断中的应用价值。方法选择疑似PJI患者62例,均拟行一期或二期髋或膝关节翻修术,以改良的肌肉与骨骼感染协会诊断标准进行诊断。将术中取出的假体进行超声裂解处理,并将所得的裂解液进行细菌培养。比较超声裂解液培养、关节液培养及假体周围组织培养对PJI的诊断效能。结果62例患者中PJI 36例、无菌性松动26例。36例PJI患者中超声裂解液培养阳性率高于关节液培养及假体周围组织培养,且与假体周围组织培养养比较差异有统计学意义(P<0.05)。26例无菌性松动患者中,有4例超声裂解液培养阳性,依据菌种鉴定结果(2例藤黄微球菌、1例表皮葡萄球菌、1例弗氏柠檬酸杆菌),提示存在标本污染的可能。超声裂解液培养灵敏度较关节液培养、假体周围组织培养高,且与假体周围组织培养比较差异有统计学意义(P<0.05);但超声裂解液培养特异度较关节液培养、假体周围组织培养低,且与关节液培养养比较差异有统计学意义(P<0.05)。5例急性感染患者中3种培养方法的灵敏度比较差异无统计学意义(P均>0.05),31例慢性感染患者中超声裂解液培养的灵敏度高于假体周围组织培养和关节液培养,且与假体周围组织培养比较差异有统计学意义(P<0.05)。4例术前2周内接受过抗生素治疗的患者超声裂解液培养的灵敏度明显高于假体周围组织培养和关节液培养(P<0.05)。27例髋关节PJI患者中超声裂解液培养的灵敏度高于关节液培养及假体周围组织培养,且与假体周围组织培养比较差异有统计学意义(P<0.05)。9例膝关节PJI患者中3种培养方法的灵敏度比较差异无统计学意义(P均>0.05)。结论超声裂解液培养可以提高PJI的检出率。

Objective To observe the application effect of sonication fluid culture in diagnosing periprosthetic joint infection(PJI).Methods Based on the modified diagnostic criteria of the Muscular Skeletal Infection Society(MSIS),62 patients with suspected PJI were selected as study subjects,and all patients were scheduled to undergo one-stage or two-stage revision surgery.The prosthesis removed during the revision surgery was subjected to undergo sonication procedure for obtained fluid culture.The difference in diagnostic efficiency of PJI between sonication fluid culture,synovial fluid cul‑ture and periprosthetic tissue culture was compared.Results There were 36 cases of PJI and 26 cases of aseptic failure in 62 patients.The positive rate of sonication fluid culture was higher than that of synovial fluid culture and periprosthetic tissue culture in 36 PJI patients,and the difference between the periprosthetic tissue culture was statistically significant(P<0.05).Of the 26 cases of aseptic failure,4 were positive for sonication fluid culture,and the possibility of specimen contamination was indicated by the results of the bacterial identification(2 cases of Micrococcus Luteus,1 case of Epider‑mal Staphylococcus,and 1 case of Citrobacter Freundii).The sensitivity of sonication fluid culture was higher than that of synovial fluid culture and periprosthetic tissue culture,and there was statistically significant difference as compared with that of the periprosthetic tissue culture(all P<0.05).However,the specificity of sonication fluid culture was lower than that of synovial fluid culture and periprosthetic tissue culture,and the difference was statistically significant as compared with that of the synovial fluid culture(all P<0.05).The sensitivity difference of three culture methods between 5 patients with acute infection was not statistically significant(P>0.05).In 31 patients with chronic infection,the sensitivity of soni‑cation fluid culture was higher than those of periprosthetic tissue culture and synovial fluid culture,and the difference was statistically significant as compared with that of the periprosthetic tissue culture(all P<0.05).In 4 patients who received antibiotics 2 weeks before surgery,the sensitivity of sonication fluid culture was significantly higher than those of peripros‑thetic tissue culture and synovial fluid culture(P<0.05).In 27 patients with hip PJI,the sensitivity of sonication fluid cul‑ture was higher than those of synovial fluid culture and periprosthetic tissue culture,and the difference was statistically sig‑nificant as compared with that of periprosthetic tissue culture(P<0.05).The sensitivity difference of three culture meth‑ods between 9 patients with knee PJI was not statistically significant(all P>0.05).Conclusion Sonication fluid culture can improve the detection rate of PJI.