Maxime van Sloten1, Joan Gómez-Junyent2, Tristan Ferry3, Nicolò Rossi4, Sabine Petersdorf5, Jeppe Lange6,7, Pablo Corona8, Miguel Araújo Abreu9, Olivier Borens10, Ovidiu Zlatian11, Dhanasekaran Soundarrajan12, S Rajasekaran12, Marjan Wouthuyzen-Bakker1. 1. Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. 2. Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain. 3. Department of Infectious and Tropical Diseases, Hospital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France. 4. Infectious Diseases Unit, University Hospital IRCCS Policlinico Sant'Orsola, Bologna, Italy. 5. Institute of Medical Laboratory Diagnostics, HELIOS University Clinic Wuppertal, Witten/Herdecke University, Witten, Germany. 6. H-HiP, Department of Orthopaedic Surgery, Regional Hospital Horsens, Horsens, Denmark. 7. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. 8. Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain. 9. Department of Infectious Diseases, Centro Hospitalar e Universitário do Porto. GRIP, Porto Bone & Joint infection group, Porto, Portugal. 10. Department of Orthopaedics and Traumatology, Septic surgical Unit, University Hospital of Lausanne, CHUV, University of Lausanne, Lausanne, Switzerland. 11. Department of Microbiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania. 12. Department of Orthopaedics, Ganga Hospital, Coimbatore, India.
Abstract
AIMS: The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld. METHODS: A multicentre observational study was undertaken: 1,553 acute and 1,556 chronic PJIs, diagnosed between 2013 and 2018, were retrospectively analyzed. Culture-negative PJIs were diagnosed according to the Muskuloskeletal Infection Society (MSIS), International Consensus Meeting (ICM), and European Bone and Joint Society (EBJIS) definitions. The primary outcome was recurrent infection, and the secondary outcome was removal of the prosthetic components for any indication, both during a follow-up period of two years. RESULTS: None of the acute PJIs and 70 of the chronic PJIs (4.7%) were culture-negative; a total of 36 culture-negative PJIs (51%) were treated with antibiotics, particularly those with histological signs of infection. After two years of follow-up, no recurrent infections occurred in patients in whom antibiotics were withheld. The requirement for removal of the components for any indication during follow-up was not significantly different in those who received antibiotics compared with those in whom antibiotics were withheld (7.1% vs 2.9%; p = 0.431). CONCLUSION: When adequate methods of culture are used, the incidence of culture-negative PJIs is low. In patients with culture-negative PJI, antibiotic treatment can probably be withheld if there are no histological signs of infection. In all other patients, diagnostic efforts should be made to identify the causative microorganism by means of serology or molecular techniques. Cite this article: Bone Joint J 2022;104-B(1):183-188.
AIMS: The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld. METHODS: A multicentre observational study was undertaken: 1,553 acute and 1,556 chronic PJIs, diagnosed between 2013 and 2018, were retrospectively analyzed. Culture-negative PJIs were diagnosed according to the Muskuloskeletal Infection Society (MSIS), International Consensus Meeting (ICM), and European Bone and Joint Society (EBJIS) definitions. The primary outcome was recurrent infection, and the secondary outcome was removal of the prosthetic components for any indication, both during a follow-up period of two years. RESULTS: None of the acute PJIs and 70 of the chronic PJIs (4.7%) were culture-negative; a total of 36 culture-negative PJIs (51%) were treated with antibiotics, particularly those with histological signs of infection. After two years of follow-up, no recurrent infections occurred in patients in whom antibiotics were withheld. The requirement for removal of the components for any indication during follow-up was not significantly different in those who received antibiotics compared with those in whom antibiotics were withheld (7.1% vs 2.9%; p = 0.431). CONCLUSION: When adequate methods of culture are used, the incidence of culture-negative PJIs is low. In patients with culture-negative PJI, antibiotic treatment can probably be withheld if there are no histological signs of infection. In all other patients, diagnostic efforts should be made to identify the causative microorganism by means of serology or molecular techniques. Cite this article: Bone Joint J 2022;104-B(1):183-188.
Authors: Ruth A Corrigan; Jonathan Sliepen; Maria Dudareva; Frank F A IJpma; Geertje Govaert; Bridget L Atkins; Rob Rentenaar; Marjan Wouthuyzen-Bakker; Martin McNally Journal: Antibiotics (Basel) Date: 2022-07-14