BACKGROUND: In presumed aseptic hip and knee revisions, it is common practice to send intraoperative cultures to screen for occult infection. Currently no guidelines exist for the routine use of acid-fast bacillus (AFB) and fungal cultures in this setting. QUESTIONS/PURPOSES: We established (1) the rate of positive fungal and AFB cultures in aseptic hip and knee revision arthroplasties, (2) factors associated with positive fungal and AFB cultures, (3) the likelihood that positive cultures represent true-positive results, and (4) the hospital charges of sending fungal and AFB cultures routinely. METHODS: We retrospectively evaluated all 1717 presumed aseptic hip and knee revisions performed from January 2006 to November 2011: 1139 patients had at least one intraoperative fungal culture and 1133 patients had at least one intraoperative AFB culture, with 923 and 920, respectively, achieving 1-year followup. The Musculoskeletal Infection Society criteria were used to classify subsequent infections. We attempted to identify risk factors for positive cultures. RESULTS: We observed six (0.5%) patients with positive AFB cultures and 19 (1.7%) with positive fungal cultures. Patients undergoing reimplantation procedures were more likely to have a positive fungal culture. The true-positive rate was 0% and 0.1% for AFB and fungal cultures, respectively. The total hospital charges for these cultures over the time frame of our study were USD 1,315,533. CONCLUSIONS: Given the extremely low rate of true-positive AFB and fungal cultures in presumed aseptic revision joint arthroplasty and the charges associated with maintaining these cultures, we believe their routine use is unwarranted. LEVEL OF EVIDENCE: Level III, prognostic study. See the Instructions for Authors for a complete description of evidence.
BACKGROUND: In presumed aseptic hip and knee revisions, it is common practice to send intraoperative cultures to screen for occult infection. Currently no guidelines exist for the routine use of acid-fast bacillus (AFB) and fungal cultures in this setting. QUESTIONS/PURPOSES: We established (1) the rate of positive fungal and AFB cultures in aseptic hip and knee revision arthroplasties, (2) factors associated with positive fungal and AFB cultures, (3) the likelihood that positive cultures represent true-positive results, and (4) the hospital charges of sending fungal and AFB cultures routinely. METHODS: We retrospectively evaluated all 1717 presumed aseptic hip and knee revisions performed from January 2006 to November 2011: 1139 patients had at least one intraoperative fungal culture and 1133 patients had at least one intraoperative AFB culture, with 923 and 920, respectively, achieving 1-year followup. The Musculoskeletal Infection Society criteria were used to classify subsequent infections. We attempted to identify risk factors for positive cultures. RESULTS: We observed six (0.5%) patients with positive AFB cultures and 19 (1.7%) with positive fungal cultures. Patients undergoing reimplantation procedures were more likely to have a positive fungal culture. The true-positive rate was 0% and 0.1% for AFB and fungal cultures, respectively. The total hospital charges for these cultures over the time frame of our study were USD 1,315,533. CONCLUSIONS: Given the extremely low rate of true-positive AFB and fungal cultures in presumed aseptic revision joint arthroplasty and the charges associated with maintaining these cultures, we believe their routine use is unwarranted. LEVEL OF EVIDENCE: Level III, prognostic study. See the Instructions for Authors for a complete description of evidence.
Authors: Khalid Azzam; Javad Parvizi; Donald Jungkind; Arlen Hanssen; Thomas Fehring; Bryan Springer; Kevin Bozic; Craig Della Valle; Luis Pulido; Robert Barrack Journal: J Bone Joint Surg Am Date: 2009-11 Impact factor: 5.284
Authors: Veronica M Wadey; James I Huddleston; Stuart B Goodman; David J Schurman; William J Maloney; Ellen J Baron Journal: J Arthroplasty Date: 2009-10-30 Impact factor: 4.757
Authors: Javad Parvizi; Dong-Hun Suh; S Mehdi Jafari; Adam Mullan; James J Purtill Journal: Clin Orthop Relat Res Date: 2011-03-02 Impact factor: 4.176
Authors: Alexia Cusini; Silvana K Rampini; Vineeta Bansal; Bruno Ledergerber; Stefan P Kuster; Christian Ruef; Rainer Weber Journal: PLoS One Date: 2010-11-16 Impact factor: 3.240
Authors: Mark J Lambrechts; Devin D St Clair; Jinpu Li; James L Cook; Bradley S Spence; Emily V Leary; Theodore J Choma; Donald K Moore; Christina L Goldstein Journal: Asian Spine J Date: 2021-11-18