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Should all patients with a culture-negative periprosthetic joint infection be treated with antibiotics? : a

Maxime van Sloten1, Joan Gómez-Junyent2, Tristan Ferry3

  • 1Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.

The Bone & Joint Journal
|December 31, 2021
PubMed
Abstract

Insights

Culture-negative periprosthetic joint infections (PJIs) are uncommon with proper culturing. Antibiotics may be withheld in culture-negative PJI cases without histological signs of infection, preventing recurrent infections.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Microbiology

Background:

  • Periprosthetic joint infections (PJIs) are a significant complication of joint replacement surgery.
  • Culture-negative PJIs pose diagnostic and therapeutic challenges.

Purpose of the Study:

  • To determine the prevalence of culture-negative PJIs using adequate culture methods.
  • To evaluate treatment outcomes for culture-negative PJIs, comparing antibiotic use versus withholding treatment.

Main Methods:

  • A multicenter observational study analyzed 1,553 acute and 1,556 chronic PJIs diagnosed between 2013 and 2018.
  • Culture-negative PJIs were defined using MSIS, ICM, and EBJIS criteria.
  • Outcomes assessed included recurrent infection and prosthetic component removal over two years.

Main Results:

  • The incidence of culture-negative PJIs was low (4.7% in chronic cases).
  • No recurrent infections occurred in patients with culture-negative PJI who withheld antibiotics.
  • Component removal rates did not differ significantly between treated and untreated groups (7.1% vs 2.9%).

Conclusions:

  • Adequate culture techniques result in a low incidence of culture-negative PJIs.
  • Antibiotic treatment can likely be withheld in culture-negative PJI cases lacking histological infection signs.
  • Further diagnostic investigations like serology or molecular techniques are recommended when infection is suspected.
Keywords:
Antibiotic treatmentCulture negativePJI definitionsPeriprosthetic joint infectionantibioticsdebridementinfectionsleucocytesmicroorganismsperiprosthetic joint infections (PJIs)prosthetic componentsrecurrent infectionsrevision surgerysynovial fluid

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