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Agreement between pre-operative and intra-operative bacteriological samples in 85 chronic peri-prosthetic infections
V Matter-Parrat1, C Ronde-Oustau1, C Boéri1
1Hôpitaux Universitaires de Strasbourg, Centre de Chirurgie Orthopédique et de la Main, Illkirch-Graffenstaden, France.
Background:
Whether pre-operative microbiological sampling contributes to the management of chronic peri-prosthetic infection remains controversial. We assessed agreement between the results of pre-operative and intra-operative samples in patients undergoing single-stage prosthesis exchange to treat chronic peri-prosthetic infection.
Hypothesis:
Agreement between pre-operative and intra-operative samples exceeds 75% in patients undergoing single-stage exchange of a hip or knee prosthesis to treat chronic peri-prosthetic infection.
Material And Methods:
This single-centre retrospective study included 85 single-stage prosthesis exchange procedures in 82 patients with chronic peri-prosthetic infection at the hip or knee. Agreement between pre-operative and intra-operative sample results was evaluated. Changes to the initial antibiotic regimen made based on the intra-operative sample results were recorded.
Results:
Of 149 pre-operative samples, 109 yielded positive cultures, in 75/85 cases. Of 452 intra-operative samples, 354 yielded positive cultures, in 85/85 cases. Agreement was complete in 54 (63%) cases and partial in 9 (11%) cases; there was no agreement in the remaining 22 (26%) cases. The complete agreement rate was significantly lower than 75% (P=0.01). The initial antibiotic regimen was inadequate in a single case.
Discussion:
Pre-operative sampling may contribute to the diagnosis of peri-prosthetic infection but is neither necessary nor sufficient to confirm the diagnosis and identify the causative agent. The spectrum of the initial antibiotic regimen cannot be safely narrowed based on the pre-operative sample results. We suggest the routine prescription of a probabilistic broad-spectrum antibiotic regimen immediately after the prosthesis exchange, even when a pathogen was identified before surgery.
Level Of Evidence:
IV, retrospective study.
Insights
Pre-operative cultures for chronic peri-prosthetic infection show limited agreement with intra-operative samples. Antibiotic regimens should remain broad-spectrum post-surgery, even with prior pathogen identification.
Area of Science:
- Orthopedic surgery
- Infectious disease
- Microbiology
Background:
- Chronic peri-prosthetic infection is a challenging complication following joint replacement surgery.
- The role of pre-operative microbiological sampling in guiding treatment remains debated.
Purpose of the Study:
- To assess the agreement between pre-operative and intra-operative microbiological samples in patients with chronic peri-prosthetic infection undergoing single-stage prosthesis exchange.
- To evaluate the impact of pre-operative sampling on antibiotic regimen adjustments.
Main Methods:
- Retrospective analysis of 85 single-stage prosthesis exchange procedures in 82 patients with hip or knee chronic peri-prosthetic infection.
- Comparison of microbiological results from pre-operative and intra-operative samples.
- Documentation of antibiotic regimen changes based on intra-operative findings.
Main Results:
- Complete agreement between pre-operative and intra-operative samples was observed in 63% of cases, which was significantly lower than the hypothesized 75% (P=0.01).
- Intra-operative samples yielded positive cultures in all 85 cases, whereas pre-operative samples were positive in 75% of cases.
- The initial antibiotic regimen was found to be inadequate in only one case.
Conclusions:
- Pre-operative microbiological sampling aids in diagnosing peri-prosthetic infection but is insufficient for definitive pathogen identification.
- Antibiotic regimens for chronic peri-prosthetic infection should not be narrowed based solely on pre-operative results.
- Routine prescription of broad-spectrum antibiotics post-surgery is recommended, irrespective of pre-operative culture data.
