Culture-negative periprosthetic joint infection: prevalence, aetiology, evaluation, recommendations, and treatment

The diagnosis of periprosthetic joint infection is sometimes straightforward with purulent discharge from the fistula tract communicating to the joint prosthesis. However it is often difficult to differentiate septic from aseptic loosening of prosthesis because of the high culture-negative rates in conventional microbiologic culture. This study used quantitative reverse transcription polymerase chain reaction (RT-qPCR) to amplify bacterial 16S ribosomal RNA in vitro and in 11 clinical samples. The in vitro analysis demonstrated that the RT-qPCR method was highly sensitive with the detection limit of bacterial 16S rRNA being 0.148 pg/μl. Clinical specimens were analyzed using the same protocol. The RT-qPCR was positive for bacterial detection in 8 culture-positive cases (including aerobic, anaerobic, and mycobacteria) and 2 culture-negative cases. It was negative in one case that the final diagnosis was confirmed without infection. The molecular diagnosis of bacterial infection using RT-qPCR to detect bacterial 16S rRNA around a prosthesis correlated well with the clinical findings. Based on the promising clinical results, we were attempting to differentiate bacterial species or drug-resistant strains by using species-specific primers and to detect the persistence of bacteria during the interim period before the second stage reimplantation in a larger scale of clinical subjects.

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Culture-negative Periprosthetic Joint Infection Does Not Preclude Infection Control

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-012-2434-0 ◽

2012 ◽

Vol 470 (10) ◽

pp. 2717-2723 ◽

Cited By ~ 47

Author(s):

Ronald Huang ◽

Chi-Chien Hu ◽

Bahar Adeli ◽

Javad Mortazavi ◽

Javad Parvizi

Keyword(s):

Infection Control ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Culture Negative

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Different diagnostic performance of plasma fibrinogen and D-dimer in periprosthetic joint infection: a propensity score matched study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04282-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Xi Chen ◽

Wenwei Qian ◽

Xisheng Weng ◽

Jin Lin ◽

Jin Jin ◽

...

Keyword(s):

Propensity Score ◽

Periprosthetic Joint Infection ◽

Predictive Value ◽

Diagnostic Performance ◽

Joint Infection ◽

Diagnostic Value ◽

Different Types ◽

Culture Positive ◽

Culture Negative ◽

D Dimer

Abstract Background Fibrinogen (Fbg) and D-dimer have been used as biomarkers for the diagnosis of periprosthetic joint infection (PJI). However, previous research has reported conflicting results on the diagnostic value of D-dimer in comparison to Fbg, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Aim This study aimed to: (1) determine the optimal threshold of plasma Fbg and D-dimer in the diagnosis of PJI and compare their diagnostic value to that of CRP and ESR; and (2) investigate whether Fbg and D-dimer perform differently than CRP and ESR as diagnostic indicators for different types of PJI. Methods A total of 115 revision cases after total hip arthroplasty (THA) and total knee arthroplasty (TKA) were identified. Based on demographic characteristics, 25 culture-positive cases were matched to 50 culture-negative cases using propensity score matching. Sensitivity, specificity, receiver operating characteristics (ROC), negative predictive value (NPV), and positive predictive value (PPV) were calculated and compared. Results The optimal thresholds were 2.72 mg/L for D-dimer, 3.655 g/L for Fbg, 12.64 mg/L for CRP, and 27 mm/h for ESR. Levels of plasma Fbg, D-dimer, CRP, and ESR were significantly higher in the culture-positive group than the culture-negative group. Fbg, D-dimer, CRP, and ESR showed sensitivity of 0.92, 0.56, 0.92, and 0.88, respectively, and showed specificity of 0.84, 0.96, 0.94, and 0.80, respectively. The ROC curve showed that CRP has the highest area under the curve (AUC) (0.94), followed by Fbg (0.90), ESR (0.87), and D-dimer (0.81). Conclusions Plasma Fbg exhibited a similar diagnostic performance compared to CRP and ESR in predicting culture-positive results in PJI. Plasma D-dimer showed high specificity but low sensitivity. In our study, Fbg and D-dimer did not show better diagnostic performance with different pathogens and different types of PJI. Further studies are required to investigate the difference between serum D-dimer and plasma D-dimer in the arthroplasty population.

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Diagnostic utility of open biopsy in patients with two culture-negative aspirations in the diagnostic work-up of periprosthetic joint infection

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04142-1 ◽

2021 ◽

Author(s):

Ianiv Klaber ◽

Fabian Scholz ◽

Mustafa Citak ◽

Akos Zahar ◽

Thorsten Gehrke ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Diagnostic Utility ◽

Open Biopsy ◽

Diagnostic Work ◽

Work Up ◽

Culture Negative ◽

Diagnostic Work Up

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Culture-Negative Periprosthetic Joint Infection

Periprosthetic Joint Infection: Practical Management Guide ◽

10.5005/jp/books/11779_29 ◽

2013 ◽

pp. 221-221

Author(s):

Carlos Higuera

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Culture Negative

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Clinical outcomes of two-stage revision for chronic periprosthetic joint infection of the knee: culture-negative versus culture-positive

Knee Surgery and Related Research ◽

10.1186/s43019-021-00112-4 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Chang-Wan Kim ◽

Chang-Rack Lee ◽

Dae-Hyun Park ◽

Doo-Yeol Kim ◽

Jeong-Woo Kim

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Reoperation Rate ◽

Negative Group ◽

Two Stage ◽

Positive Group ◽

Negative Culture ◽

Significant Difference ◽

Culture Positive ◽

Culture Negative

Abstract Background The effect of negative culture on the treatment outcomes of chronic periprosthetic joint infection (PJI) is still controversial. The purpose of this study is to evaluate whether the outcomes of two-stage revision in culture-negative chronic PJI differ from those in culture-positive PJI. Methods The patients who received two-stage revisions due to chronic PJI during the period between 2007 and 2017 were retrospectively reviewed. The culture-negative and culture-positive PJI group included 57 cases and 79 cases, respectively. The demographic data, as well as reoperation, mortality, reinfection, and failure rates of each group were evaluated. Results There was a significant difference in reoperation rate between the two groups for the period from the first-stage surgery to the second-stage revision arthroplasty (p = 0.045). The reoperation rate of the culture-positive group was 25.3% (20/79) whereas that of the culture-negative group was 10.5% (6/57). Among the 136 PJI cases, 97 cases (71.3%) received reimplantation surgery (culture-negative group, 43 cases; culture-positive group, 54 cases). No significant difference was noted between the culture-negative and culture-positive groups with respect to the number of cases that did not undergo reimplantation surgery and the reoperation, reinfection, mortality, and failure rates after two-stage surgery (p > 0.05, all parameters). Conclusions The culture outcome had no significant effect on the outcome of the two-stage revision in patients with chronic PJI. The reoperation rate after first-stage surgery was significantly higher in the culture-positive group, but the overall failure rate did not significantly differ in both the groups. The presence of a negative culture might be a good prognostic factor for chronic PJI.

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