Culture-negative periprosthetic joint infection: prevalence, aetiology, evaluation, recommendations, and treatment

Area of Science:

• Orthopedics
• Infectious Diseases
• Microbiology

Background:

• Periprosthetic joint infection (PJI) is a severe complication following total joint arthroplasty (TJA).
• Managing PJI is difficult, particularly when the causative microorganism remains unidentified.
• Culture-negative PJI poses a significant clinical challenge.

Purpose of the Study:

• To systematically review and guide the diagnostic approach for culture-negative PJI.
• To provide evidence-based treatment recommendations for culture-negative PJI.
• To enhance the management strategies for patients with culture-negative PJI.

Main Methods:

• A systematic review of clinical studies was conducted using major biomedical databases (MEDLINE, EMBASE, Cochrane Library, Scopus).
• Exclusion criteria included basic science studies, letters, non-English articles, case reports, and review articles.
• Focus was on studies relevant to the diagnosis and treatment of PJI.

Main Results:

• Culture-negative PJI constitutes 5-42% of all PJIs.
• Factors influencing culture negativity include prior antibiotic use, inadequate culture methods, and insufficient incubation.
• Recommended diagnostic strategies involve repeat sampling, extended incubation, sonication, PCR, and next-generation sequencing. Vancomycin and cephalosporins are common treatments, with two-stage revision achieving 70-100% success.

Conclusions:

• A comprehensive, evidence-based guide for managing culture-negative PJI has been developed.
• The review emphasizes advanced diagnostic techniques to identify causative pathogens.
• Effective treatment strategies, including surgical revision, are crucial for successful outcomes.