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Operative Cultures Rarely Necessitate Change to Periprosthetic Joint Infection Antibiotic Plan Based on Monomicrobial
Merrick T Ducharme1, Khaled A Elmenawi1, Hervé Poilvache1
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Background:
Periprosthetic joint infections (PJI) are complex to manage and frequently result in prolonged hospitalization while awaiting outpatient antibiotic therapy coordination. Moving this work to the preoperative setting for nonemergent PJI cases could potentially provide more efficient and cost-effective care. This study sought to evaluate the appropriateness of antibiotic treatment plans based upon monomicrobial preoperative cultures.
Methods:
We identified 925 PJIs (312 hips of 613 knees) in 831 patients treated at a single institution between 2013 and 2022. Preoperative aspirations were culture negative in 171 joints (18%) and had polymicrobial growth in 107 joints (12%), leaving 641 joints (70%) with a single-organism PJI based on preoperative culture from which an antibiotic treatment plan could be made. Operative cultures were evaluated for concordance with preoperative cultures. An infectious disease specialist reviewed discordant results for clinical significance and whether a change in antibiotic therapy was necessary.
Results:
Among the 641 PJIs with a single organism identified preoperatively, an antibiotic plan based on preoperative culture was appropriate for 97% of PJIs. Only 17 PJIs (3%) had discordant operative cultures requiring a change in antibiotic plan. Compared with preoperative culture results, operative cultures were concordant in 484 PJIs (76%); negative in 80 PJIs (12%); discordant but determined to be a contaminant by an infectious disease specialist in 52 PJIs (8%); and discordant, but still appropriately covered by the preoperative antibiotic plan in eight PJIs (1%).
Conclusions:
In 70% of PJIs, preoperative aspiration yields a single identifiable pathogen. An antibiotic plan targeting this pathogen will be highly likely to provide effective therapy. These findings suggest that most PJI treatment regimens can be finalized preoperatively to facilitate earlier hospital dismissal and potentially more cost-effective PJI care.
Level Of Evidence:
III.
Insights
Finalizing antibiotic plans before surgery for periprosthetic joint infections (PJI) is effective in most cases. This approach can lead to earlier hospital discharge and more cost-effective PJI care.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Microbiology
Background:
- Periprosthetic joint infections (PJI) pose significant management challenges, often leading to extended hospital stays.
- Coordinating outpatient antibiotic therapy for PJI requires substantial time and resources.
- Preoperative planning for nonemergent PJI cases offers a potential for improved efficiency and cost savings.
Purpose of the Study:
- To assess the appropriateness of antibiotic treatment plans based on preoperative cultures in PJI cases.
- To determine the feasibility of finalizing antibiotic regimens before surgical intervention.
Main Methods:
- Retrospective analysis of 925 PJI cases (hips and knees) treated between 2013 and 2022.
- Evaluation of preoperative aspiration cultures for pathogen identification (monomicrobial vs. polymicrobial vs. negative).
- Comparison of preoperative and operative culture results for concordance and clinical significance.
Main Results:
- In 70% of PJI cases, preoperative cultures identified a single pathogen, enabling targeted antibiotic planning.
- Antibiotic plans based on preoperative cultures were appropriate for 97% of monomicrobial PJI cases.
- Only 3% of cases required antibiotic regimen changes due to discordant operative cultures.
Conclusions:
- Preoperative aspiration successfully identifies a single pathogen in a majority of PJI cases.
- Targeted antibiotic therapy based on preoperative cultures is highly effective.
- Finalizing PJI treatment regimens preoperatively can streamline care, reduce hospital stays, and lower costs.
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