BACKGROUND AND PURPOSE Identification of pathogens causing fracture-device-related infection (FDRI) is always a challenge as the positive rate of standard tissue sampling culture (TSC) remains unsatisfactory. This study evaluates the efficiency of implant surface culture (ISC) as an adjunct to standard TSC for identification of FDRI-associated microorganisms. PATIENTS AND METHODS Between November 2020 and March 2022, patients diagnosed with FDRI defined by the International Fracture-Related Infection (FRI) Consensus Group, and indicated for implant removal, underwent both methods for bacteria detection. The test order of ISC and TSC was randomly selected for each patient included, as a within-person randomized design. For ISC, the recovered implants were gently covered with tryptic soy agar after rinsing with normal saline twice, and then incubated at 37℃ 5% CO2 for up to 14 days. For TSC, 5 specimens were sampled and sent to the Clinical Laboratory of Southern Medical University Nanfang Hospital, Guangzhou, for culture and identification. RESULTS 42 consecutive patients were included, with a mean age of 46 years. The most frequent infection site and implant type were the tibia (21 cases) and plates with screws (30 cases), respectively. Altogether 21 patients were found with positive outcomes by both methods, and the identified pathogens were consistent. ISC found an additional 15 patients showing positive results, which were negative by TSC. Furthermore, the mean culture time of ISC was shorter than that of TSC (1.5 days vs. 3.2 days). INTERPRETATION ISC may be a useful adjunct to TSC for detection of bacteria causing FDRI, with a relatively higher positive rate and a shorter culture time.

中文翻译：

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植入物表面培养可能是标准组织取样培养的有用辅助手段，用于鉴定导致骨折装置相关感染的病原体：一项针对 42 名患者的个人内部随机协议研究。

背景和目的 鉴定导致骨折装置相关感染 (FDRI) 的病原体始终是一个挑战，因为标准组织取样培养 (TSC) 的阳性率仍然不能令人满意。本研究评估了植入物表面培养 (ISC) 作为标准 TSC 的辅助手段用于鉴定 FDRI 相关微生物的效率。患者和方法 在 2020 年 11 月至 2022 年 3 月期间，被国际骨折相关感染 (FRI) 共识小组诊断为 FDRI 且需要移除植入物的患者接受了两种细菌检测方法。ISC 和 TSC 的测试顺序是为每个包括的患者随机选择的，作为个人随机设计。对于 ISC，回收的植入物在用生理盐水冲洗两次后用胰蛋白酶大豆琼脂轻轻覆盖，然后在 37℃ 5% CO2 条件下培养 14 天。TSC取5份标本送广州南方医科大学南方医院临床检验科进行培养鉴定。结果 连续纳入 42 名患者，平均年龄为 46 岁。最常见的感染部位和植入物类型分别是胫骨（21 例）和带螺钉的钢板（30 例）。两种方法共发现 21 例患者结果为阳性，鉴定出的病原体一致。ISC 发现另外 15 名患者显示阳性结果，而 TSC 为阴性。此外，ISC 的平均培养时间比 TSC 短（1.5 天对 3.2 天）。解释 ISC 可能是 TSC 的有用辅助手段，用于检测引起 FDRI 的细菌，