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Updated: Jul 5, 2026
Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis
Published on: May 23, 2021
Brucella periprosthetic joint infection: epidemiology, precision diagnosis, and management-a comprehensive review and
Hongyin Fu1, Song Sun1, Libo Zhao1
1Department of Orthopaedics, The Second Hospital of Lanzhou University, Lanzhou, China.
Objectives:
To describe diagnostic delay and treatment burden in Brucella periprosthetic joint infection (PJI) and propose a stratified evidence-informed clinical framework.
Methods:
We comprehensively reviewed published cases of Brucella PJI and summarized data from 80 patients to describe epidemiology, clinical features, diagnosis, treatment, and reported outcomes.
Results:
Of 80 patients, 59.72% were not diagnosed before initial treatment. Low culture yield and failure to meet conventional PJI criteria appeared to contribute to delayed recognition. Fifty-five percent received ≥3 treatment courses, and 55.30% had a total treatment duration ≥4.5 months, often in the context of misdiagnosis and staged revision surgery. Combining exposure history with serology and molecular diagnostics may facilitate diagnostic recognition. Antimicrobial therapy, with or without drainage, may be appropriate for stable prostheses, whereas one-stage revision plus antibiotics was associated with shorter hospitalization and potentially lower treatment burden in loosened prostheses.
Conclusion:
Based on observational data predominantly from case reports, we propose an evidence-informed framework incorporating multi-modal diagnostics and individualized surgical strategies that may improve recognition and outcomes while potentially reducing treatment burden in Brucella PJI. Validation in prospective studies is required.
Insights
Brucella periprosthetic joint infection (PJI) diagnosis is often delayed, leading to increased treatment burden. A new framework using multi-modal diagnostics and tailored surgery may improve outcomes for Brucella PJI patients.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Clinical Microbiology
Background:
- Brucella periprosthetic joint infection (PJI) presents diagnostic challenges.
- Delayed diagnosis contributes to significant treatment burden and poorer outcomes.
Purpose of the Study:
- To characterize diagnostic delays and treatment burden in Brucella PJI.
- To propose a stratified, evidence-informed clinical framework for managing Brucella PJI.
Main Methods:
- Comprehensive literature review of published Brucella PJI cases.
- Data synthesis from 80 patients focusing on epidemiology, clinical presentation, diagnosis, treatment, and outcomes.
Main Results:
- Over 59% of patients were not diagnosed before initial treatment, attributed to low culture yield and atypical PJI criteria.
- 55% received ≥3 treatment courses, with 55.3% treated for ≥4.5 months, often due to misdiagnosis and staged surgeries.
- Combining exposure history, serology, and molecular diagnostics aids recognition; treatment strategies vary by prosthesis stability (antimicrobials for stable, one-stage revision for loosened).
Conclusions:
- An evidence-informed framework integrating multi-modal diagnostics and individualized surgical approaches is proposed.
- This framework may enhance recognition, improve outcomes, and reduce treatment burden in Brucella PJI.
- Prospective studies are needed to validate the proposed framework.
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