Culture-negative periprosthetic joint infection

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Medical Microbiology

Background:

• Negative culture results present a significant diagnostic challenge for periprosthetic joint infection (PJI).
• Pre-operative antibiotic administration is a primary reason for culture-negative PJI, complicating pathogen identification.

Purpose of the Study:

• To outline strategies for improving the diagnostic yield of microbial cultures in suspected periprosthetic joint infection.
• To provide guidance on optimizing sample collection and processing to enhance pathogen detection.

Main Methods:

• Review of current diagnostic practices and literature for periprosthetic joint infection.
• Recommendations include delaying antibiotic administration until after joint aspiration or diagnosis.
• Techniques such as expeditious sample transport, appropriate media, implant sonication, and extended incubation are discussed.

Main Results:

• Delaying antibiotics until after sample collection significantly increases the likelihood of positive cultures.
• Multiple tissue samples (3-5) during revision surgery are recommended if initial aspiration is negative.
• Implant sonication and prolonged incubation (2-3 weeks) can enhance pathogen recovery.

Conclusions:

• Optimizing the timing of antibiotic administration and employing specific sample handling techniques are crucial for diagnosing PJI.
• Molecular methods and biomarkers show promise for future PJI diagnosis when cultures are negative.