AUTHOR=Yusuf Erlangga , Roschka Charlotte , Esteban Jaime , Raglio Annibale , Tisler Anna , Willems Philippe , Kramer Tobias Siegfried 

TITLE=The State of Microbiology Diagnostic of Prosthetic Joint Infection in Europe: An In-Depth Survey Among Clinical Microbiologists

JOURNAL=Frontiers in Microbiology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2022.906989

DOI=10.3389/fmicb.2022.906989

ISSN=1664-302X

ABSTRACT=Background
The aim of this study is to give an overview on how microbiology diagnosis tests of PJI is performed in Europe, and to explore whether any factor influences the decision on implementing a test.

Methods
An in-depth online survey among clinical microbiologists in seven European countries (Belgium, Estonia, Germany, Italy, The Netherlands, Switzerland, and Spain). Following items were assessed: (i). general information on the laboratory, (ii) preference of the laboratory and clinical microbiologists regarding samples, (iii) transportation and (iv) processing of explanted foreign bodies and tissues and synovial fluid, (v) culture media and culture duration, (vi) reporting (identification and susceptibility testing), and (vii) use of molecular microbiology techniques. 

Results
Invited were 163 clinical microbiologists. The response rate from each country was above 50% (range 51% to 78%)), except for Germany (36%). Frequent PJI diagnostics were the use of tissue pre-processing (58.1%), culturing synovial fluid in blood culture bottles (45.5%), use of sonication for processing explanted prosthesis (56.8%), reporting presence of synovial leukocyte counts (67%), use of blood aerobic and anaerobic agar (97.7%), and enrichment media thioglycolate (69.3%). The most common incubation time of the culture media is 7 to 14 days (34.1% to 70.5%). The clinicians were called to report culture results (80.7%), and to give antibiotic recommendation (67%). 

Conclusion
There are common practices in processing PJI samples and reporting results, which is promising for harmonization of PJI diagnostic in the future. However, variation in diagnostic tests should also be considered in interpreting and comparing clinical microbiology results.