PMID- 24343249
OWN - NLM
STAT- MEDLINE
DCOM- 20140925
LR  - 20220310
IS  - 1531-2291 (Electronic)
IS  - 0890-5339 (Linking)
VI  - 28
IP  - 7
DP  - 2014 Jul
TI  - Can we trust intraoperative culture results in nonunions?
PG  - 384-90
LID - 10.1097/BOT.0000000000000043 [doi]
AB  - OBJECTIVES: To identify the presence of bacterial biofilms in nonunions comparing 
      molecular techniques (multiplex polymerase chain reaction and mass spectrometry, 
      fluorescent in situ hybridization) with routine intraoperative cultures. METHODS: 
      Thirty-four patients with nonunions were scheduled for surgery and enrolled in 
      this ongoing prospective study. Intraoperative specimens were collected from 
      removed implants, surrounding tissue membrane, and local soft tissue followed by 
      standard culture analysis, Ibis's second generation molecular diagnostics (Ibis 
      Biosystems), and bacterial 16S rRNA-based fluorescence in situ hybridization 
      (FISH). Confocal microscopy was used to visualize the tissue specimens reacted 
      with the FISH probes, which were chosen based on the Ibis analysis. RESULTS: 
      Thirty-four patient encounters were analyzed. Eight were diagnosed as infected 
      nonunions by positive intraoperative culture results. Ibis confirmed the presence 
      of bacteria in all 8 samples. Ibis identified bacteria in a total of 30 of 34 
      encounters, and these data were confirmed by FISH. Twenty-two of 30 Ibis-positive 
      samples were culture-negative. Four samples were negative by all methods of 
      analysis. No samples were positive by culture, but negative by molecular 
      techniques. CONCLUSIONS: Our preliminary data indicate that molecular diagnostics 
      are more sensitive for identifying bacteria than cultures in cases of bony 
      nonunion. This is likely because of the inability of cultures to detect biofilms 
      and bacteria previously exposed to antibiotic therapy. LEVEL OF EVIDENCE: 
      Diagnostic Level I. See Instructions for Authors for a complete description of 
      levels of evidence.
FAU - Palmer, Michael P
AU  - Palmer MP
AD  - *Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA; 
      daggerDepartment of Orthopaedic Surgery, Allegheny General Hospital, Drexel University 
      College of Medicine and Temple University School of Medicine, Pittsburgh, PA; 
      double daggerDivision of Orthopaedic Trauma, Allegheny General Hospital, Pittsburgh, PA; 
       section signDepartment of Orthopaedic Surgery, Temple University School of Medicine, 
      Pittsburgh, PA;  ||Department of Orthopaedic Surgery, Drexel University College of 
      Medicine, Pittsburgh, PA;  paragraph signCenter for Genomic Sciences, Allegheny-Singer Research 
      Institute, Pittsburgh, PA; **Department of Microbiology and Immunology, Drexel 
      University College of Medicine, Philadelphia, PA; and daggerdaggerPenn State University, 
      State College, PA.
FAU - Altman, Daniel T
AU  - Altman DT
FAU - Altman, Gregory T
AU  - Altman GT
FAU - Sewecke, Jeffrey J
AU  - Sewecke JJ
FAU - Ehrlich, Garth D
AU  - Ehrlich GD
FAU - Hu, Fen Z
AU  - Hu FZ
FAU - Nistico, Laura
AU  - Nistico L
FAU - Melton-Kreft, Rachel
AU  - Melton-Kreft R
FAU - Gause, Trent M 3rd
AU  - Gause TM 3rd
FAU - Costerton, John W
AU  - Costerton JW
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Orthop Trauma
JT  - Journal of orthopaedic trauma
JID - 8807705
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Bacteriological Techniques
MH  - *Biofilms
MH  - Device Removal
MH  - Female
MH  - Fractures, Ununited/*microbiology
MH  - Humans
MH  - In Situ Hybridization, Fluorescence
MH  - Intraoperative Period
MH  - Male
MH  - Mass Spectrometry
MH  - Middle Aged
MH  - Multiplex Polymerase Chain Reaction
MH  - Prostheses and Implants/*microbiology
MH  - Prosthesis-Related Infections/*diagnosis/*microbiology
MH  - Young Adult
EDAT- 2013/12/18 06:00
MHDA- 2014/09/26 06:00
CRDT- 2013/12/18 06:00
PHST- 2013/12/18 06:00 [entrez]
PHST- 2013/12/18 06:00 [pubmed]
PHST- 2014/09/26 06:00 [medline]
AID - 10.1097/BOT.0000000000000043 [doi]
PST - ppublish
SO  - J Orthop Trauma. 2014 Jul;28(7):384-90. doi: 10.1097/BOT.0000000000000043.