Bacteriological sampling in revision surgery: When, how, and with what therapeutic impact?

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Microbiology

Background:

• Bacteriological sampling in orthopedic revision surgery presents challenges regarding timing, methodology, and interpretation.
• Standardized protocols are needed to optimize diagnostic accuracy for periprosthetic joint infections and internal fixation revisions.

Purpose of the Study:

• To provide evidence-based recommendations for optimal bacteriological sampling during orthopedic revision surgery.
• To clarify best practices for sample collection, transport, and interpretation to improve infection diagnosis.

Main Methods:

• Systematic review of existing literature and expert opinion.
• Analysis of sampling strategies, timing, number of samples, transport conditions, and interpretation classifications.
• Evaluation of antibiotic washout periods and the impact of antibiotic prophylaxis.

Main Results:

• Sampling should be performed only in cases of suspected infection, not systematically.
• Deep tissue samples are preferred, ideally collected after a sufficient antibiotic-free period (14-21 days).
• The European Bone and Joint Infection Society (EBJIS) classification demonstrated high sensitivity for diagnosing infection.

Conclusions:

• Optimized bacteriological sampling protocols are essential for accurate diagnosis of orthopedic implant infections.
• Adherence to recommended practices for sample collection, timing, and interpretation improves diagnostic yield.
• Further research may refine guidelines, particularly for atypical infections and antibiotic management.