Culture-Negative Prosthetic Joint Infection

Abstract

Background. Culture-negative (CN) prosthetic joint infection (PJI) has not been well studied. We performed a retrospective cohort study to define the demographic characteristics and determine the outcome of patients with CN PJI.Methods. All cases of CN total hip arthroplasty and total knee arthroplasty infections (using a strict case definition) treated at our institution from January 1990 through December 1999 were analyzed. Kaplan-Meier survival methods were used to determine the cumulative probability of success.Results. Of 897 episodes of PJI during the study period, 60 (7%) occurred in patients for whom this was the initial episode of CN PJI. The median age of the cohort was 69 years (range, 36-87 years). Patients had received a prior course of antimicrobial therapy in 32 (53%) of 60 episodes. Of the 60 episodes, 34 (57%), 12 (20%), and 8 (13%) were treated with 2-stage exchange, debridement and retention, and permanent resection arthroplasty, respectively. The median duration of parenteral antimicrobial therapy was 28 days (range, 0-88 days). Forty-nine (82%) of 60 episodes were treated with a cephalosporin. The 5-year estimate of survival free of treatment failure was 94% (95% confidence interval, 85%-100%) for patients treated with 2-stage exchange and 71% (95% confidence interval, 44%-100%) for patients treated with debridement and retention.Conclusions. CN PJI occurs infrequently at our institution. Prior use of antimicrobial therapy is common among patients with CN PJI. CN PJI treated at our institution is associated with a rate of favorable outcome that is comparable to that associated with PJI due to known bacterial pathogens.

Premature Therapeutic Antimicrobial Treatments Can Compromise the Diagnosis of Late Periprosthetic Joint Infection

“…However, the available tests for diagnosis of PJI are far from perfect. Cultures, for example, are negative in 7% to 12% of patients with PJI [5,10,16,19]. Culture-negative PJI can potentially complicate case classification and management and is an additional source of stress for both the patient and surgeon.…”

“…Culture-negative PJI can potentially complicate case classification and management and is an additional source of stress for both the patient and surgeon. Antimicrobial treatments have been reported to be a cause of culture-negative PJI [5,17].…”

“…Although the adverse effects of antibiotic administration on culture results has been well studied [5,15,26] and the clinical practice guideline of the American Academy of Orthopaedic Surgeons (AAOS) recommends withholding antibiotics for at least 2 weeks before aspiration to increase the culture yield [8], it is still unknown whether preaspiration antibiotic administration can affect synovial fluid cell counts and serology results.…”

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

“…contamination of samples may result in false-positive results [6]. Some authors have suggested different adjunctive criteria [5,27,36,38] to overcome shortcomings of bacteriologic culture, leading to discrepancy in their inclusion and exclusion criteria.…”

Broad-Range PCR in Selected Episodes of Prosthetic Joint Infection

“…The technique is based on the amplification of bacterial 16S ribosomal DNA [6]. Criteria for definite PJI included the presence of a sinus tract communicating with the prosthesis or purulence surrounding the prosthesis at the time of surgery or acute or chronic inflammation consistent with infection on histopathologic examination [1,7]. Infection was excluded when the above-mentioned criteria were not fulfilled, no antimicrobial treatment was administered after the episode, and no relapse occurred for at least 1 year.…”