Use and Cost-Effectiveness of Intraoperative Acid-Fast Bacilli and Fungal Cultures in Assessing Infection of Joint Arthroplasties

Wadey, Veronica M.; Huddleston, James I.; Goodman, Stuart B.; Schurman, David J.; Maloney, William J.; Baron, Ellen J.

doi:10.1016/j.arth.2009.08.018

« Previous Next »The Journal of Arthroplasty
Volume 25, Issue 8 , Pages 1231-1234, December 2010

Use and Cost-Effectiveness of Intraoperative Acid-Fast Bacilli and Fungal Cultures in Assessing Infection of Joint Arthroplasties

Veronica M. Wadey, MD, FRCSC
- Department of Surgery, Division of Orthopaedic Surgery, Faculty of Medicine, Holland Orthopaedic and Arthritis Centre and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Reprint requests: Veronica M. Wadey, BPHE, BEd, MD, MA, FRCSC, Department of Surgery, Division of Orthopaedic Surgery, Faculty of Medicine, Holland Orthopaedic and Arthritic Centre and Sunnybrook Health Sciences Centre, University of Toronto, 43 Wellesley Street East, Suite 621, Toronto, Ontario, Canada M4Y 1H1.
James I. Huddleston, MD, FRCS
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford University Medical Center, School of Medicine, Stanford, California
Stuart B. Goodman, MD, PhD, FRCS
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford University Medical Center, School of Medicine, Stanford, California
David J. Schurman, MD, FRCS
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford University Medical Center, School of Medicine, Stanford, California
William J. Maloney, MD, FRCS
- Department of Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford University Medical Center, School of Medicine, Stanford, California
Ellen J. Baron, PhD
- Department of Pathology, Stanford Hospital and Clinics, Stanford University Medical Center, School of Medicine, Stanford, CA, California

Received 7 March 2009; accepted 24 August 2009. published online 02 November 2009.

Abstract

The objective of this study is to determine a protocol for collecting acid-fast bacilli (AFB) and fungal intraoperative cultures during orthopedic procedures. An observational study was undertaken. Four hundred forty-six AFB cultures and 486 fungal cultures were processed over a 2-year period. The number of positive cultures was determined. A protocol specific to handling these types of specimens was developed. Cost analysis was completed to determine both the time and money saved if the new protocol was implemented. The infrequency of positive AFB and fungal cultures in this study suggests that it is only necessary to routinely request AFB and fungal cultures on 1 of 5 samples. Implementation of this protocol has potential to lead to substantial cost reduction and resource savings without diminishing patient outcomes.

Keywords: periprosthetic infection, AFB fungal infections