Impact of Sonication Fluid Cultures on Prosthetic Joint Infection Diagnosis and Management: A Microbiology-Driven Evaluation Using Infectious Diseases Society of America and European Bone and Joint Infection Society Criteria.

Abstract

Most studies investigating the role of sonication fluid culture on periprosthetic joint infections (PJIs) focused on diagnostic accuracy, without assessing its potential impact on patient management. This study aims to evaluate how the use of sonication fluid culture may alter the diagnosis and management of PJI. Included were 429 patients (mean age [SD], 68 [11] year; 65% male) who underwent explantation of a knee or hip prosthesis due to suspected PJI or aseptic causes. Because the Infectious Diseases Society of America (IDSA) PJI criteria do not include sonication in the diagnostic definition, we compared sonication fluid culture results with intraoperative tissue cultures patient-per-patient. In contrast, the European Bone and Joint Society (EBJIS) criteria include both sonication and tissue cultures. For EBJIS-confirmed criteria, we calculated the proportion of cases meeting the sonication fluid culture criterion of >50 colony-forming units (CFU)/ ml, and the number of cases where sonication identified additional microorganisms than tissues. Among 95 PJI cases defined by IDSA criteria, sonication fluid culture would not alter patient management in 61 (64.2%) cases, as findings were fully concordant with tissue cultures. In 8 (8.4%) cases, sonication detected an additional virulent microorganism that could influence antibiotic selection. According to EBJIS criteria, 113 cases were classified as confirmed; 50 (44.2%) met the definition based solely on a positive sonication fluid culture >50 CFU/ml. In 10 of these 50 patients (20%), sonication influenced antibiotic selection by identifying additional low-virulence microorganisms. Sonication fluid culture may influence clinical management in approximately 8% to 20% of PJI cases.