Beverly L Hersh1, Neel B Shah2, Scott D Rothenberger3, Jason P Zlotnicki4, Brian A Klatt4, Kenneth L Urish5. 1. University of Pittsburgh School of Medicine, Pittsburgh, PA. 2. Division of Infectious Disease, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. 3. Division of General Internal Medicine, Center for Research on Health Care Data Center, University of Pittsburgh School of Medicine, Pittsburgh, PA. 4. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. 5. Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA.
Abstract
BACKGROUND: Diagnosis and treatment of culture negative total knee arthroplasty (TKA) periprosthetic joint infection (PJI) is challenging. There is debate over whether culture negative PJI confers increased risk of failure and which organisms are responsible. It is also unclear as to what factors predict conversion from culture negative to culture positivity. To address these issues, we performed an observational study to detect factors associated with transition from culture negative to culture positive TKA PJI in those patients that failed irrigation and debridement (I&D), determine the incidence of this transition, and identify those organisms that were associated with treatment failure. METHODS: A multicenter observational cohort study was performed on patients with TKA PJI as defined by Musculoskeletal Infection Society criteria without cultured organisms and treated with I&D. Primary outcome was failure defined as any subsequent surgical procedure. Secondary outcome included cultured organism within 2 years of initial I&D. RESULTS: Two hundred sixteen TKA I&D procedures were performed for PJI, and 36 met inclusion criteria. The observed treatment failure rate for culture negative PJI treated with I&D was 41.67%. Of those culture negative I&Ds that failed, 53.33% became culture positive after failure. Of those that converted to culture positive, 62.5% were Staphylococcus species. The odds ratio associated with becoming culture positive following culture negative treatment failure in the setting of antibiotic administration prior to the initial I&D procedure was 0.69 (95% confidence interval 0.14-3.47, P = .65). CONCLUSION: Many cases of culture negative TKA PJI treated with I&D eventually fail and become culture positive. Staphylococci are common organisms identified after culture negative PJI.
BACKGROUND: Diagnosis and treatment of culture negative total knee arthroplasty (TKA) periprosthetic joint infection (PJI) is challenging. There is debate over whether culture negative PJI confers increased risk of failure and which organisms are responsible. It is also unclear as to what factors predict conversion from culture negative to culture positivity. To address these issues, we performed an observational study to detect factors associated with transition from culture negative to culture positive TKA PJI in those patients that failed irrigation and debridement (I&D), determine the incidence of this transition, and identify those organisms that were associated with treatment failure. METHODS: A multicenter observational cohort study was performed on patients with TKA PJI as defined by Musculoskeletal Infection Society criteria without cultured organisms and treated with I&D. Primary outcome was failure defined as any subsequent surgical procedure. Secondary outcome included cultured organism within 2 years of initial I&D. RESULTS: Two hundred sixteen TKA I&D procedures were performed for PJI, and 36 met inclusion criteria. The observed treatment failure rate for culture negative PJI treated with I&D was 41.67%. Of those culture negative I&Ds that failed, 53.33% became culture positive after failure. Of those that converted to culture positive, 62.5% were Staphylococcus species. The odds ratio associated with becoming culture positive following culture negative treatment failure in the setting of antibiotic administration prior to the initial I&D procedure was 0.69 (95% confidence interval 0.14-3.47, P = .65). CONCLUSION: Many cases of culture negative TKA PJI treated with I&D eventually fail and become culture positive. Staphylococci are common organisms identified after culture negative PJI.
Authors: Kenneth L Urish; Peter W DeMuth; Brian W Kwan; David W Craft; Dongzhu Ma; Hani Haider; Rocky S Tuan; Thomas K Wood; Charles M Davis Journal: Clin Orthop Relat Res Date: 2016-07 Impact factor: 4.176
Authors: Andrej Trampuz; Kerryl E Piper; Melissa J Jacobson; Arlen D Hanssen; Krishnan K Unni; Douglas R Osmon; Jayawant N Mandrekar; Franklin R Cockerill; James M Steckelberg; James F Greenleaf; Robin Patel Journal: N Engl J Med Date: 2007-08-16 Impact factor: 91.245
Authors: Kenneth L Urish; Andrew G Bullock; Alexander M Kreger; Neel B Shah; Kwonho Jeong; Scott D Rothenberger Journal: J Arthroplasty Date: 2017-11-21 Impact factor: 4.757
Authors: Brian P Conlon; Sarah E Rowe; Autumn Brown Gandt; Austin S Nuxoll; Niles P Donegan; Eliza A Zalis; Geremy Clair; Joshua N Adkins; Ambrose L Cheung; Kim Lewis Journal: Nat Microbiol Date: 2016-04-18 Impact factor: 17.745