Clinical characteristics and risk factors for culture-negative periprosthetic joint infections

Abstract

Background Culture-negative periprosthetic joint infections (PJIs) can complicate diagnosis and management of PJI. This study aimed to identify risk factors for culture-negative PJI and differences in clinical characteristics between culture-positive and culture-negative PJI group. Methods This retrospective, cross-sectional study evaluated PJI cases obtained between January 2013 and October 2019 at our institution. These PJI cases were divided into culture-positive and culture-negative groups and then compared. The demographics, laboratory findings, and details of patient’s clinical characteristics were investigated. Univariate and multivariate logistic regression analysis were performed to investigate risk factors for culture-negative PJI. Results A total of 109 PJI cases were included in the analysis: 82 (75%) culture-positive and 27 (25%) culture-negative. The mean serum white blood cell (WBC) count, C-reactive protein level, and erythrocyte sedimentation rate in the culture-negative group were significantly lower than those in the culture-positive group (p < 0.05). There were no significant differences between the two groups regarding history of prior antibacterial administration or treatment success rates. Multivariate analysis identified a low serum WBC count as a risk factor for culture-negative PJI (odds ratio = 0.78; 95% confidence interval [CI] = 0.63–0.97; p = 0.027). Conclusions A low serum WBC count is a risk factor for culture-negative PJI, but prior antimicrobial therapy is not. The results suggest that PJI cases with lower levels of systemic inflammation are likely to be culture-negative; therefore, the possibility of a culture-negative result should be considered in suspected cases of PJI with low inflammatory markers, regardless of prior antibiotic exposure.

Global Cluster Analysis and Network Visualization in Prosthetic Joint Infection: A Scientometric Mapping

“…3A, The USA had the highest number of total citations (79,694), followed by the UK (11,838), Germany (11,762), Switzerland (8607), and France (6076). When ranked by H-index, the USA came first (125) followed by the UK (67), Germany (57), Switzerland (54) and France (43), which matched the ranking order based on total number of citations.…”

“…Currently, about three to five distinct intraoperative tissue samples has to be collected 56 . The frequency of culture‐negative PJI might be caused by several factors, such as prior antibiotics administration, a biofilm formation on the implants, and culture conditions 57 . Some novel techniques, such as synovial fluid culture in blood bottles, could improve the sensitivity 58,59 .…”

“…56 The frequency of culture-negative PJI might be caused by several factors, such as prior antibiotics administration, a biofilm formation on the implants, and culture conditions. 57 Some novel techniques, such as synovial fluid culture in blood bottles, could improve the sensitivity. 58,59 Other techniques included sonication of removed prosthetic components 60,61 and optimum incubation conditions.…”

A comparsion study between debridement, antibiotics, and implant retention and two-stage revision total knee arthroplasty for the management of periprosthetic joint infection occurring within 12 weeks from index total knee arthroplasty

“…Infecting organisms were recorded and analyzed according to the results of preoperative aspiration and intraoperative pathology. Culture negative was defined as being culture-negative result for all samples (at least three consecutive negative culture results) [ 13 ]. And all DAIR procedures included polyethylene exchange.…”

Synovial fluid S100A8, S100A9, and HNP 1-3 in the diagnosis of periprosthetic joint infection: a prospective, double-blind trial

“…Although MSIS criteria already exist to assist clinicians diagnose PJI, sinus tracts are found at a low rate, with only 4 of 39 PJI patients included in this study having sinus tracts. Moreover, PJI patients with negative culture results were mainly attributed to low-virulence microorganisms' infection, premature antibiotic therapy, and incapable adoption of enriched medium culture [23]. The prevalence of culturenegative PJI has been reported to vary between 5% and 42% [24].…”