Surgical Sampling Procedures

Despite the development of percutaneous sampling techniques in bone and joint infections, surgical sampling procedures remain useful in obtaining better specimen quality. In order to fully execute the sampling technique and identify the causative germ, correct storage and fast transportation to microbiology laboratory are mandatory. Swab, fine-needle aspiration, indirect imprint technique, joint puncture, tissue biopsy, and implant sonication are the procedures mainly used. Depending on the clinical presentation, the surgeon can use one or more techniques. In primary bone and joint infections, surgical sampling procedures are used in emergency cases in which surgery is indicated. Specimens must be taken before beginning antibiotic treatment. In fracture-related infection, deep tissue biopsy remains the gold standard, allowing multiple samples to be obtained at the bone implant interface. In chronic prosthetic joint infection, joint puncture under strict aseptic conditions is largely useful for establishing diagnosis. In case of inconclusive result of puncture, multiple deep tissue biopsies remain the gold standard. In infections after spine surgery, CT-scan guided biopsy avoids the risk of sometimes unnecessary and complicated surgical revision. In this chapter, sampling procedures for different conditions of primary or postoperative bone and joint infection are exposed.