In vitro assessment of bacterial translocation during needle insertion through inoculated culture media as a model of arthrocentesis through cellulitic tissue

Travis T. Smyth Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4 Canada.

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Manuel Chirino-Trejo Department of Veterinary Microbiology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4 Canada.

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James L. Carmalt Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4 Canada.

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Abstract

OBJECTIVE To determine by use of an in vitro model the potential for translocating sufficient numbers of bacteria into a joint during arthrocentesis through cellulitic tissue to cause sepsis.

SAMPLE Culture media containing 4 concentrations of Staphylococcus aureus and needles of 3 sizes.

PROCEDURES Needles (22, 20, and 19 gauge) were inserted through Mueller-Hinton agar that contained known concentrations of S aureus (103,104,105, and 106 CFUs/mL). After a needle exited through the medium, any agar plug within the needle bore was ejected into a sterile syringe and the contaminated portion of the needle was harvested. Sterile saline (0.9% NaCl) solution was used to emulsify the agar plug and wash the contaminated portion of the needle. The resulting solution was cultured to determine the number of bacterial CFUs that could be deposited into a joint during arthrocentesis through contaminated tissue.

RESULTS Needle gauge and bacterial concentration were both associated with the number of bacterial CFUs deposited after insertion through contaminated agar. Although all needle sizes were capable of bacterial translocation sufficient to cause septic arthritis, ORs for 20- and 22-gauge needles translocating > 33 CFUs of S aureus were significantly higher than the OR for a 19-gauge needle. The ORs for 20- or 22-gauge needles translocating > 33 CFUs of S aureus (the minimum population of S aureus known to cause joint sepsis) were 0.22.

CONCLUSIONS AND CLINICAL RELEVANCE Results for this in vitro model indicated that caution should be used when performing arthrocentesis through cellulitic tissue.

Abstract

OBJECTIVE To determine by use of an in vitro model the potential for translocating sufficient numbers of bacteria into a joint during arthrocentesis through cellulitic tissue to cause sepsis.

SAMPLE Culture media containing 4 concentrations of Staphylococcus aureus and needles of 3 sizes.

PROCEDURES Needles (22, 20, and 19 gauge) were inserted through Mueller-Hinton agar that contained known concentrations of S aureus (103,104,105, and 106 CFUs/mL). After a needle exited through the medium, any agar plug within the needle bore was ejected into a sterile syringe and the contaminated portion of the needle was harvested. Sterile saline (0.9% NaCl) solution was used to emulsify the agar plug and wash the contaminated portion of the needle. The resulting solution was cultured to determine the number of bacterial CFUs that could be deposited into a joint during arthrocentesis through contaminated tissue.

RESULTS Needle gauge and bacterial concentration were both associated with the number of bacterial CFUs deposited after insertion through contaminated agar. Although all needle sizes were capable of bacterial translocation sufficient to cause septic arthritis, ORs for 20- and 22-gauge needles translocating > 33 CFUs of S aureus were significantly higher than the OR for a 19-gauge needle. The ORs for 20- or 22-gauge needles translocating > 33 CFUs of S aureus (the minimum population of S aureus known to cause joint sepsis) were 0.22.

CONCLUSIONS AND CLINICAL RELEVANCE Results for this in vitro model indicated that caution should be used when performing arthrocentesis through cellulitic tissue.

Contributor Notes

Address correspondence to Dr. Carmalt (james.carmalt@usask.ca).
  • 1. Swartz MN. Cellulitis. N Engl J Med 2004; 350: 904912.

  • 2. Fjordbakk CT, Arroyo LG, Hewson J. Retrospective study of the clinical features of limb cellulitis in 63 horses. Vet Rec 2008; 162: 233236.

    • Search Google Scholar
    • Export Citation
  • 3. Schneider RK, Bramlage LR, Moore LM, et al. A retrospective study of 192 horses affected with septic arthritis tenosynovitis. Equine Vet J 1992; 24: 436442.

    • Search Google Scholar
    • Export Citation
  • 4. Wright IM, Smith MR, Humphrey DJ, et al. Endoscopic surgery in the treatment of contaminated and infected synovial cavities. Equine Vet J 2003; 35: 613619.

    • Search Google Scholar
    • Export Citation
  • 5. Bertone AL, Jones RL, McIlwraith CW. Serum and synovial fluid steady-state concentrations of trimethoprim and sulfadiazine in horses with experimentally induced infectious arthritis. Am J Vet Res 1988; 49: 16811687.

    • Search Google Scholar
    • Export Citation
  • 6. Bertone AL, McIlwraith CW, Jones RL, et al. Povidone-iodine lavage treatment of experimentally induced equine infectious arthritis. Am J Vet Res 1987; 48: 712715.

    • Search Google Scholar
    • Export Citation
  • 7. Bertone AL, McIlwraith CW, Jones RL, et al. Comparison of various treatments for experimentally induced equine infectious arthritis. Am J Vet Res 1987; 48: 519529.

    • Search Google Scholar
    • Export Citation
  • 8. Gustafson SB, McIlwraith CW, Jones RL. Comparison of the effect of polysulfated glycosaminoglycan, corticosteroids, and sodium hyaluronate in the potentiation of a subinfective dose of Staphylococcus aureus in the middle carpal joint of horses. Am J Vet Res 1989; 50: 20142017.

    • Search Google Scholar
    • Export Citation
  • 9. Gustafson SB, McIlwraith CW, Jones RL, et al. Further investigations into the potentiation of infection by intra-articular injection of polysulfated glycosaminoglycan and the effect of filtration and intra-articular injection of amikacin. Am J Vet Res 1989; 50: 20182022.

    • Search Google Scholar
    • Export Citation
  • 10. Robson MC. Infection in the surgical patient: an imbalance in the normal equilibrium. Clin Plast Surg 1979; 6: 493503.

  • 11. Mah RA, Fung DY, Morse SA. Nutritional requirements of Staphylococcus aureus S-6. Appl Microbiol 1967; 15: 866870.

  • 12. Breed RS, Dotterrer WD. The number of colonies allowable on satisfactory agar plates. J Bacteriol 1916; 1: 321331.

  • 13. Sutton S. Counting colonies. Available at: www.microbiol.org/resources/monographswhite-papers/counting-colonies/. Accessed May 13, 2014.

    • Search Google Scholar
    • Export Citation
  • 14. Zubrod CJ, Farnsworth KD, Oaks LJ. Evaluation of arthrocentesis site bacterial flora before and after 4 methods of preparation in horses with and without evidence of skin contamination. Vet Surg 2004; 33: 525530.

    • Search Google Scholar
    • Export Citation
  • 15. Dohoo I, Martin W, Stryhn H. Model-building strategies. In: Dohoo I, Martin W, Stryhn H, eds. Veterinary epidemiologic research. 2nd ed. Charlottetown, PE, Canada: VER Inc, 2012365–394.

    • Search Google Scholar
    • Export Citation
  • 16. Waxman SJ, Adams SB, Moore GE. Effect of needle brand, needle bevel grind, and silicone lubrication on contamination of joints with tissue and hair debris after arthrocentesis. Vet Surg 2014; 43: 16.

    • Search Google Scholar
    • Export Citation
  • 17. Hague BA, Honnas CM, Simpson BR, et al. Evaluation of skin bacterial flora before and after aseptic preparation of clipped and nonclipped arthrocentesis sites in horses. Vet Surg 1997; 26: 121125.

    • Search Google Scholar
    • Export Citation
  • 18. Wahl K, Adams SB, Moore GE. Contamination of joints with tissue debris and hair after arthrocentesis: the effect of needle insertion angle, spinal needle gauge, and insertion of spinal needles with and without a stylet. Vet Surg 2012; 41: 391398.

    • Search Google Scholar
    • Export Citation
  • 19. Selwyn S, Ellis H. Skin bacteria and skin disinfection reconsidered. Br Med J 1972; 15: 136140.

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