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Orthopedic-implant-associated infection is a relatively rare complication of primary arthroplasties (1-2%). In the recent years, however, an increase in such infections is observed as the joint replacement prosthesis has become a common procedure in orthopedic surgery. Orthopedic implant-associated infections pathogenesis is related to the microorganism ability to grow in biofilms, embedded in a polymeric matrix. The biofilm protects microorganisms from antibiotics as well as the host’s immunity mechanisms. These microbes are difficult to separate from the biofilm, which renders diagnosis of such infections particularly difficult. Therefore, we presume that low infection rates reported tend to be underestimated, as lοw-grade infection is often perceived as aseptic failure. An important tool for diagnosis of such infections is a novel method, namely sonication of the removed implants, followed by culture of sonication fluid, first described and standardized by A. Trampuz a few years ago. The conventional culture methods applied till then, using synovial fluid or intraoperative tissue for culturing, are characterized by low sensitivity (e.g. about 54% using intraoperative tissue), with 10-30% false negative results, and/or lack of specificity. Sonication of explanted implants may attain removal of the attached biofilm. The fluid cultured after sonication is enriched in biomembrane bacteria, thus increasing sensitivity of the method (about 75%). The sonication method has been applied to orthopedic implants, breast implants, neurosurgical shunts and cardiac devices. Granulicatella belongs to the streptococcus family, more specifically the “nutritionally variant streptococci”. It was described circa 1960 by Frenkel and Hirsch in an endocarditis case. In 2000 it has been classified as a separate genus and subdivided into 3 different species, namely G. adiacens, G. elegans and G. balaenopterae. G. adiacens is a catalase-negative and oxydase-negative, Abstract

Application of a sonication fluid vial culture method to diagnosis of prosthetic knee joint infection caused by Granulicatella adiacens