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Published on: December 3, 2017
Preoperative synovial fluid culture poorly predicts the pathogen causing periprosthetic joint infection
Philipp Schulz1, Constantin E Dlaska2, Carsten Perka1
1Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, 10117, Berlin, Germany.
Purpose:
We investigated the value of preoperative pathogen detection and evaluated its concordance with intraoperative cultures in patients with culture-positive periprosthetic joint infection (PJI).
Methods:
Culture-positive PJI episodes with available preoperative (synovial fluid) and intraoperative cultures (periprosthetic tissue, synovial or sonication fluid) were analyzed. The pathogen detection rate in preoperative and intraoperative cultures was compared using Fisher's exact test and their concordance was calculated.
Results:
Among 167 included PJI episodes, 150 were monomicrobial with coagulase-negative staphylococci (n = 55, 37%), S. aureus (n = 34, 23%), and streptococci (n = 21, 14%) being the most common pathogens. Seventeen episodes (10%) were polymicrobial infections. The pathogen(s) grew in preoperative culture in 110 and in intraoperative cultures in 153 episodes (66% vs. 92%, p < 0.001). The pathogen detection rate was lower in preoperative compared to intraoperative cultures for low-virulent pathogens (40% vs. 94%, p < 0.001), polymicrobial infections (59% vs. 100%, p = 0.007), and in delayed and late PJI (63% vs. 94%, and 66% vs. 91%, respectively, p < 0.001). Full concordance of preoperative and intraoperative cultures was found in 87 episodes (52%). The pathogen was detected solely preoperatively in 14 episodes (8%) and solely intraoperatively in 57 cases (34%); an additional pathogen was found in 3 episodes (2%) preoperatively and in 6 episodes (4%) intraoperatively.
Conclusion:
The concordance of preoperative and intraoperative cultures was poor (52%). The sole or an additional pathogen was found exclusively in intraoperative cultures in 38% of PJI episodes, hence preoperative synovial fluid cultures are considered unreliable for pathogen detection in PJI.
Insights
Preoperative synovial fluid cultures are unreliable for pathogen detection in periprosthetic joint infection (PJI). Intraoperative cultures identified pathogens exclusively in 38% of cases, highlighting the limitations of preoperative testing for PJI diagnosis.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
- Accurate pathogen identification is crucial for effective PJI treatment and management.
- Preoperative diagnostic methods are essential for guiding surgical and antimicrobial strategies.
Purpose of the Study:
- To evaluate the diagnostic value of preoperative pathogen detection in PJI.
- To assess the concordance between preoperative synovial fluid cultures and intraoperative cultures.
- To determine the reliability of preoperative cultures for identifying causative pathogens in PJI.
Main Methods:
- Analysis of culture-positive PJI cases with available preoperative (synovial fluid) and intraoperative cultures.
- Comparison of pathogen detection rates between preoperative and intraoperative samples.
- Calculation of concordance between preoperative and intraoperative culture results using statistical tests.
Main Results:
- A total of 167 PJI episodes were analyzed; coagulase-negative staphylococci, S. aureus, and streptococci were the most common pathogens.
- Pathogen detection rates were significantly lower in preoperative cultures (66%) compared to intraoperative cultures (92%).
- Full concordance between preoperative and intraoperative cultures was observed in only 52% of cases, with pathogens exclusively identified intraoperatively in 38% of episodes.
Conclusions:
- Preoperative synovial fluid cultures demonstrate poor concordance with intraoperative cultures in PJI.
- A significant proportion of PJI cases have pathogens detected exclusively in intraoperative samples.
- Preoperative synovial fluid cultures are considered unreliable for definitive pathogen detection in PJI management.
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