Use of an automated blood culture system (BD BACTECTM) for diagnosis of prosthetic joint infections: easy and fast

Background: For the diagnosis of prosthetic joint infection (PJI) automated BACTEC(TM) blood culture bottle methods have comparable sensitivity, specificity and a shorter time to positivity than traditional cooked meat enrichment broth methods. We evaluate the culture incubation period required to maximise sensitivity and specificity of microbiological diagnosis, and the ability of BACTEC(TM) to detect slow growing Propionibacteria spp. Methods: Multiple periprosthetic tissue samples taken by a standardised method from 332 patients undergoing prosthetic joint revision arthroplasty were cultured for 14 days, using a BD BACTEC(TM) instrumented blood culture system, in a prospective study from 1st January to 31st August 2012. The "gold standard" definition for PJI was the presence of at least one histological criterion, the presence of a sinus tract or purulence around the device. Cases where > = 2 samples yielded indistinguishable isolates were considered culture-positive. 1000 BACTEC(TM) bottle cultures which were negative after 14 days incubation were sub-cultured for Propionibacteria spp. Results: 79 patients fulfilled the definition for PJI, and 66 of these were culture-positive. All but 1 of these 66 culture-positive cases of PJI were detected within 3 days of incubation. Only one additional (clinically-insignificant) Propionibacterium spp. was identified on terminal subculture of 1000 bottles. Conclusions: Prolonged microbiological culture for 2 weeks is unnecessary when using BACTEC(TM) culture methods. The majority of clinically significant organisms grow within 3 days, and Propionibacteria spp. are identified without the need for terminal subculture. These findings should facilitate earlier decisions on final antimicrobial prescribing.