Use of thioglycolate broth as a pre-analytic transport medium in the diagnosis of prosthetic joint infection
Christopher Lim1
, Iswadi Damasena2, Duncan Mclellan3, Markus Kuster4
1Department of Orthopaedics, Fiona Stanley Hospital, Perth, Australia
2Department of Orthopaedics, Box Hill Hospital, Melbourne, Australia
3Department of Infectious Diseases, Joondalup Health Campus, Perth, Australia
4Department of Orthopaedics, Sir Charles Gairdner Hospital, Perth, Australia
Keywords: Cutibacterium acnes, hip arthroplasty, knee arthroplasty, Prosthetic joint infection, thioglycolate.
Abstract
Objectives: This study aimed to investigate whether adding tissue samples directly into thioglycolate (TG) broth yielded a greater number of anaerobic organisms than freshly sampled tissue in suspected hip and knee prosthetic joint infections (PJIs).
Patients and methods: Between January 2017 and December 2020, a total of 90 patients (46 males, 44 females; median age: 71.7 years; range, 50.8 and 87.8 years) who underwent revision hip or knee arthroplasty were included. Intraoperative samples were taken, with five placed in TG broth and five in standard containers (PC) with subsequent aerobic and anaerobic culturing conducted. Demographic and baseline data of the patients were recorded. The primary outcome was positive bacterial growth from a PJI specimen inoculated directly into TG broth at the time of collection or standard PJI specimen processing. Secondary outcomes investigated were the presence of Cutibacterium acnes (C. acnes) and the curative success of revision procedure.
Results: A total of 900 samples (450 PC and 450 TG) were taken from 90 revision arthroplasty patients (47 knees and 43 hips). There was no statistically significant difference in the number of positive bacterial growth samples between TG broth and standard processing (p=0.742). This was consistent with subgroup analysis analyzing C. acnes (p=0.666).
Conclusion: In hip and knee arthroplasty, there is no benefit in substituting or adding TG broth as a culture medium to better identify both general bacterial species and C. acnes infections specifically. However, the use of TG may be useful in confirming a true positive result for infection.
Citation: Lim C, Damasena I, Mclellan D, Kuster M. Use of thioglycolate broth as a pre-analytic transport medium in the diagnosis of prosthetic joint infection. Jt Dis Relat Surg 2024;35(2):299-304. doi: 10.52312/jdrs.2024.1364.
The study protocol was approved by the Hollywood Private Hospital Research Ethics Committee (date: 08.02.2016, no: HPH446). The study was conducted in accordance with the principles of the Declaration of Helsinki.
A written informed consent was obtained from each patient.
Was responsible for data collection, statistical analysis, interpretation of the data and writing of the manuscript: C.L.; Was responsible for ethical consideration of the paper, interpretation of the data and editing of the manuscript: I.D.; Was responsible for data collection, interpretation and editing of the manuscript: D.M.; Was responsible the initial concept of the paper, interpretation of the data and editing of the manuscript: M.K.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The data that support the findings of this study are available from the corresponding author upon reasonable request.