Drain tip culture following total knee arthroplasty

Are systematic drain tip or drainage fluid cultures predictive of surgical site infections?

“…The flow-chart is presented in Figure 1. Seventeen studies were selected (Tables I and II) [5,7,8,[17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”

“…When studying the concordance between the drain tip or drainage fluid cultures and the SSI isolated bacteria, PPVs were very low (6%, 95% CI [0-23] for drain tip cultures and 7%, 95% CI [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] for drainage fluid cultures) (Supplemental material 2).…”

“…We included 17 studies involving 4,390 patients for drain tip cultures and 1,288 patients for drainage fluid cultures. Although an association between positive cultures and SSI was observed in several included studies, several of them did not show the performances in terms of NPV, PPV, sensitivity and specificity of these cultures [17,21,24,29]. Our metaanalysis allowed us to determine these performances in the prediction of SSI and to pool them.…”

“…Systematic drain tip or drainage fluid cultures seem to be of little value since the PPVs that represent the probability of SSI in the presence of a positive culture were low (11%, 95% CI for drain tip cultures and 12%, 95% CI for drainage fluid cultures). Moreover, the micro-organisms identified in the cultures did not systematically correspond to the microorganisms involved in SSI (PPVs of 6%, 95% CI [0-23] for drain tip cultures and 7%, 95% CI [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] for drainage fluid cultures). Sensitivities were also poor; thus systematic drain tip or 8 drainage fluid cultures are not reliable predictors of SSI in the absence of clinical signs.…”

“…The Newcastle-Ottawa scale was preferred to the QUADAS-2 [33] scale usually used for the assessment of diagnostic accuracy studies as the Newcastle-Ottawa scale allowed us to evaluate more items. Only the evaluation of the presence of SSI without knowledge of the culture was not assessed, but this information was never mentioned in selected studies [5,7,8,[17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”