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Impact of Positive Cultures During the Second Stage of a Two-Stage Exchange: Systematic Review and Meta-Analysis

Marta Sabater-Martos1, Laia Boadas1, Rihard Trebše2

  • 1Orthopedic and Traumatology Department, Hospital Clínic de Barcelona, Barcelona, Spain.

The Journal of Arthroplasty
|September 27, 2023
PubMed
Abstract

Insights

Positive cultures during two-stage exchange for periprosthetic joint infection increase failure risk. However, withholding antibiotics before reimplantation in these cases may lower failure rates, warranting further study.

Area of Science:

  • Orthopedic surgery
  • Infectious disease
  • Medical research methodology

Background:

  • Two-stage exchange is common for periprosthetic joint infection.
  • Positive cultures at second stage are a suspected risk factor for reinfection.
  • The impact of positive cultures and antibiotic holidays on outcomes needs clarification.

Approach:

  • Systematic literature search across four databases.
  • Meta-analysis of complication risks associated with positive second-stage cultures.
  • Subgroup analysis examining the effect of antibiotic holidays.

Key Points:

  • Positive cultures during the second stage significantly increased failure rates (OR 4.05).
  • Failure rates were higher with positive cultures regardless of antibiotic holidays.
  • Withholding antibiotics before reimplantation in positive culture cases showed a trend towards lower failure (15% vs 17.3%, P=.21).

Conclusions:

  • Microbiological eradication was not achieved in 18% of cases, correlating with higher failure.
  • Withholding antibiotics in positive culture cases was linked to a lower failure rate.
  • Optimal antibiotic strategies for two-stage exchange procedures require further investigation.
Keywords:
2-stagePJIculturesexchangefailure

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