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Risk of Obtaining Routine Cultures During Presumed Aseptic Orthopaedic Procedures

Matthew A Napierala1, Jaime L Bellamy2, Clinton K Murray2

  • 1Fort Leonard Wood Army Community Hospital, Fort Leonard Wood, Missouri.

Journal of Surgical Orthopaedic Advances
|February 21, 2018
PubMed

Insights

Routine antibiotic use for orthopedic surgeries may increase complications without preventing late infections. Cultures often don't match the infection, suggesting a need to reconsider routine antibiotic selection based on these cultures.

Area of Science:

  • Orthopaedic Surgery
  • Infectious Disease
  • Pharmacology

Background:

  • Antibiotic selection based on routine cultures from presumed aseptic orthopaedic procedures is common practice.
  • The efficacy and potential risks of this practice, particularly regarding late deep infections and antibiotic-related complications, require evaluation.

Purpose of the Study:

  • To assess whether routine cultures from aseptic orthopaedic procedures improve outcomes.
  • To determine the association between routine cultures, antibiotic treatment, and the incidence of late deep infections.
  • To evaluate the rate of antibiotic-related complications in patients undergoing orthopaedic procedures.

Main Methods:

  • Retrospective analysis of 169 presumed aseptic orthopaedic procedures.
  • Data collection on routine cultures, positive/negative results, antibiotic treatment, late deep infections, and antibiotic-related complications.
  • Comparison of infection rates between groups with positive cultures, negative cultures, and no cultures.

Main Results:

  • Routine cultures were obtained in 60 procedures (35.5%), with 38.3% positive and 61.7% negative.
  • Twenty-two patients (13.5%) developed late infections; 7/14 (50%) with positive cultures treated with antibiotics developed infection.
  • Antibiotic-related complications occurred in 29% of patients treated with antibiotics (p = .01), and microorganism correlation was only 55.5%.

Conclusions:

  • Routine antibiotic selection based on cultures from aseptic orthopaedic procedures may increase complication risks.
  • This practice does not appear to reduce the rate of late deep infection.
  • The low correlation between routine cultures and causative microorganisms suggests a need to re-evaluate current antibiotic stewardship protocols.

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