Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results

Abstract

Summary Summary: Many physicians and surgeons think that prescribing antibiotics before intraoperative sampling does not alter the microbiological results. Methods: Case-control study of adult patients hospitalized with orthopedic infections. Results: Among 2740 episodes of orthopedic infections, 1167 (43%) had received antibiotic therapy before surgical sampling. Among these, 220 (19%) grew no pathogens while the proportion of culture-negative results in the 2573 who had no preoperative antibiotic therapy was only 6%. By multivariate analyses, pre-operative antibiotic exposure was associated with significantly more culture-negative results (odds ratio 2.8, 95% confidence interval 2.1e3.7), more non-fermenting rods and skin commensals (odds ratio 2.8 and 3.0, respectively). Even a single pre-operative dose of antibiotic was significantly associated with subsequent culture-negative results (19/93 vs. 297/2350; c 2 -test, p Z 0.01) and skin commensals (17/74 vs. 274/2350; p Z 0.01) compared to episodes without preceding prophylaxis. Conclusions: Prior antibiotic use, including single-dose prophylactic administrations, is three-fold associated with culture-negative results, non-fermenting rods and resistant skin commensals.

Stopping antibiotics after surgical amputation in diabetic foot and ankle infections—A daily practice cohort

“…Also, since we included all hospitalized patients, this study reflects real‐life conditions at our centre's clinical practice, thus reducing selection bias. Our rate of clinical recurrence (17%) is similar to that reported in the literature (15%, 18% and 19% depending on the studies). This is equally true regarding our microbiology‐confirmed recurrence rate of 8%, which is shared by other groups (6%‐8%, 9%, and 8%) as well.…”

“…Prior to admission or initial surgical procedure, 96 episodes (20%) already received systemic antibiotic therapy, but exact data on duration or dosage are lacking. Following amputation, median duration of systemic antibiotic administration was 7 days (IQR, 1‐16 days) and median duration of parenteral use was 5 days (IQR, 0‐12 days).…”

Pyogenic Arthritis of the Fingers and the Wrist: Can We Shorten Antimicrobial Treatment Duration?

“…If the waiting time for surgery is significant, patients may receive preemptive antibiotic therapy. This practice can alter the microbiological results of intraoperatively obtained samples [18]. Although we did not find a statistical difference in bacterial growth between patients with and without antimicrobial prophylaxis, we cannot estimate the role of antimicrobial agents in susceptible microorganisms only.…”

How Do Preoperative Antibiotics Affect Culture Yield in Diabetic Foot Infections?

“…Zhorne et al [7] reported that longer durations of preoperative antibiotics were associated with more culture-negative results in cases of pediatric hematogenous osteomyelitis. Similarly, in a retrospective cohort of patients with mixed orthopedic infections, Al-Mayahi et al [6] found that 19% of patients who received preoperative antibiotics had culture-negative results, whereas only 6% of those who did not receive preoperative antibiotics had culture-negative results. In contrast, Ghanem et al [11] found no statistical difference in the proportion of negative tissue cultures between patients with total knee arthroplasty infection who were exposed and not exposed to perioperative antibiotics.…”

“…Previous authors have shown that a single perioperative antibiotic administered before operations for suspected prosthetic joint infection is not associated with a larger proportion of negative cultures [3, 4]. The effect of multiple days of antibiotics on operative cultures has been studied in revision hip arthroplasty [5], mixed orthopedic infections [6], pediatric osteomyelitis [7], and pyogenic vertebral osteomyelitis [8, 9] with conflicting results. The effect of preoperative antibiotics on DFI cultures has not been studied.…”