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Cultures in periprosthetic joint infections, the imperfect gold standard?
1Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Abstract:
Culture-negative periprosthetic joint infections (PJI) are commonly described in the literature. By implementing a routine diagnostic workup and by optimizing tissue sampling and processing, the culture-negative rate can easily be reduced. When faced with a culture-negative PJI, several serological and molecular techniques are available that may aid in finding the causative microorganism. Clinical clues may guide the treating physician towards more atypical and rare microorganisms. A multidisciplinary team consisting of orthopaedic surgeons, microbiologists and infectious disease specialist are warranted in tailoring diagnostic testing and deciding on the surgical and antibiotic treatment approach.
Insights
Culture-negative periprosthetic joint infections (PJI) can be reduced with optimized diagnostics. Serological and molecular methods, alongside clinical clues, help identify causative microbes in challenging PJI cases.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Culture-negative periprosthetic joint infections (PJI) present diagnostic challenges.
- Optimizing tissue sampling and processing can decrease the rate of culture-negative PJIs.
Purpose of the Study:
- To outline strategies for reducing culture-negative rates in PJI.
- To highlight diagnostic tools for identifying causative microorganisms in culture-negative PJI.
- To emphasize the importance of a multidisciplinary approach in managing PJI.
Main Methods:
- Implementing routine diagnostic workup.
- Optimizing tissue sampling and processing techniques.
- Utilizing serological and molecular diagnostic methods.
- Considering clinical clues for atypical microorganisms.
Main Results:
- The culture-negative rate in PJI can be significantly reduced through improved diagnostic protocols.
- Serological and molecular techniques offer valuable alternatives for pathogen identification when cultures are negative.
- Clinical expertise is crucial for suspecting and detecting rare causative agents.
Conclusions:
- Optimized diagnostic workup and tissue handling are essential for minimizing culture-negative PJIs.
- Advanced diagnostic techniques and clinical acumen are vital for managing culture-negative PJI.
- A collaborative approach involving orthopaedic surgeons, microbiologists, and infectious disease specialists ensures comprehensive patient care for PJI.
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