A comprehensive review of the diagnosis and management of prosthetic joint infections in the absence of positive cultures

Abstract

The diagnosis and management of prosthetic joint infections (PJI) with negative cultures remains an enigma without clear definitions and guidelines for its management. In contrast, the literature offers guidelines to the diagnosis and management of culture positive prosthetic joint infections as noted in both the infectious disease literature and the orthopedic literature. This paper outlines the current state of knowledge of PJI with negative cultures and summarizes the recommendations for the work up and management of this condition. In addition, we propose a simple algorithm that clinicians may find useful for the management of PJI with negative cultures. This algorithm has not been validated with data at this point, but can be applied to practice to help direct the management and diagnosis of prosthetic joint infections in the absence of positive cultures.

Identifying Common Pathogens in Periprosthetic Joint Infection and Testing Drug‐resistance Rate for Different Antibiotics: A Prospective, Single Center Study in Beijing

“…We also included patients with aseptic loosening because some patients might have low‐grade infections in this group. Gram‐positive bacterium is still the most common pathogenic bacteria in PJI, accounting for over 50% of cases, and in our study the proportion of isolated G+ bacteria was 86.9% (60/69); Staphylococcus epidermidis and Staphylococcus aureus were the largest in number.…”

Unraveling the host's immune response to infection: Seeing is believing

“…As discussed here, certain bacterial pathogens like Borrelia can home to the joints during a systemic infection; however, another common cause of joint infections is prosthetic surgery. Over a million prosthetic surgeries are performed each year and the incidence of infection ranges from 1% to 4%, with more than 50% of these infections caused by Staphylococcus aureus and coagulase‐negative staphylococci . Thus, further investigations into the role of the immune system in clearing bacteria from the joint are warranted.…”

“…Over a million prosthetic surgeries are performed each year and the incidence of infection ranges from 1% to 4%, with more than 50% of these infections caused by Staphylococcus aureus and coagulase-negative staphylococci. 57 Thus, further investigations into the role of the immune system in clearing bacteria from the joint are warranted.…”

The use of polymerase chain reaction in the diagnosis and management of prosthetic joint infections: a debatable issues at this time

“…It has been reported that 12-20% of all prostheses are found to be infected after primary revision surgeries. [8][9][10] There are several demographic factors and co-morbid conditions that put patients at a higher risk for PJIs such an overweight male, age greater than 65 years, immunosuppression, and a history of previous revision. 8,11,5 Additionally, other studies have shown that obesity and increasing BMI puts patients at a greater risk for infections.…”