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

Abstract

Background In the absence of positive cultures and draining sinuses, the diagnosis of periprosthetic joint infection (PJI) relies on laboratory values. It is unknown if administration of antibiotics within 2 weeks before diagnostic evaluations can affect these tests in patients with PJI. Questions/purposes The purpose of this study was to investigate the correlation of antibiotic administration with (1) fluctuations in the synovial fluid and serology laboratory values; and (2) sensitivity of the diagnostic tests in patients with late PJI (per Musculoskeletal Infection Society [MSIS] criteria). Methods Synovial white blood cell (WBC) count, polymorphonuclear neutrophil (PMN) percentage, and serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as culture results were investigated in 161 patients undergoing total knee arthroplasty with late PJI diagnosed with the MSIS criteria. Depending on whether presampling antibiotics were used, patients were divided in two groups (53 [33%] patients were on antibiotics). The median laboratory values and the false-negative rates were compared between the two groups.

The role of biomarkers in the diagnosis of periprosthetic joint infection

“…In addition, a recent study from our institution has shown that the administration of systemic antibiotics to patients with PJI may compromise the results of these laboratory values. 19 …”

Leukocyte Esterase as a Biomarker in the Diagnosis of Periprosthetic Joint Infection

“…The reasons for the diagnostic difficulty include the absence of specific clinical signs and symptoms, the relative lack of accurate laboratory tests, and low culture rate in isolation of pathogens due to prior therapy and formation of biofilms [14,15]. The MSIS recently responded to this diagnostic difficulty by developing a definition for PJI [16]. Although clinically useful, this definition remains complex and time consuming due to the subjective observation of purulence and interpretation of the frozen section histology and the low culture rate, all of which cause delay in diagnosis.…”

Current Review; Biomarkers in Diagnosing Periprosthetic Joint Infection

“…There is no gold standard for diagnosing PJI, hence, a clinician who encounters a suspected PJI case, ought to use a combination of tests. All of which, besides their expense can be invasive and even this can't provide 100% accuracy [2]. Several biomarkers have been introduced that are potentially reliable tools for diagnosing PJI [3].…”

“…Recent evidence suggests that PJI with slowgrowing organisms may not result in a fully-fledged physiological response and hence may not result in elevation of ESR and CRP in the serum, raising a concern for the sensitivity of these tests. Furthermore, a study by our group showed that the administration of systemic antibiotics can significantly compromise the results of these laboratory values [2]. It is imperative for clinicians to consider the timing of infection prior to assessing patients' ESR and CRP results, as these markers are frequently elevated in the early postoperative period.…”