Comparative meta-omics for identifying pathogens associated with prosthetic joint infection

AbstractProsthetic joint infections (PJI) are economically and personally costly, and their incidence has been increasing in the United States. Herein, we compared 16S rRNA amplicon sequencing (16S), shotgun metagenomics (MG) and metatranscriptomics (MT) in identifying pathogens causing PJI. Samples were collected from 30 patients, including 10 patients undergoing revision arthroplasty for infection, 10 patients receiving revision for aseptic failure, and 10 patients undergoing primary total joint arthroplasty. Synovial fluid and peripheral blood samples from the patients were obtained at time of surgery. Analysis revealed distinct microbial communities between primary, aseptic, and infected samples using MG, MT, (PERMANOVA p = 0.001), and 16S sequencing (PERMANOVA p < 0.01). MG and MT had higher concordance with culture (83%) compared to 0% concordance of 16S results. Supervised learning methods revealed MT datasets most clearly differentiated infected, primary, and aseptic sample groups. MT data also revealed more antibiotic resistance genes, with improved concordance results compared to MG. These data suggest that a differential and underlying microbial ecology exists within uninfected and infected joints. This study represents the first application of RNA-based sequencing (MT). Further work on larger cohorts will provide opportunities to employ deep learning approaches to improve accuracy, predictive power, and clinical utility.

Download Full-text

Improved Diagnosis of Prosthetic Joint Infection by Culturing Periprosthetic Tissue Specimens in Blood Culture Bottles

mBio ◽

10.1128/mbio.01776-15 ◽

2016 ◽

Vol 7 (1) ◽

Cited By ~ 55

Author(s):

Trisha N. Peel ◽

Brenda L. Dylla ◽

John G. Hughes ◽

David T. Lynch ◽

Kerryl E. Greenwood-Quaintance ◽

...

Keyword(s):

Blood Culture ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Broth Culture ◽

Periprosthetic Tissue ◽

Tissue Samples ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Tissue Specimens

ABSTRACTDespite known low sensitivity, culture of periprosthetic tissue specimens on agars and in broths is routine. Culture of periprosthetic tissue samples in blood culture bottles (BCBs) is potentially more convenient, but it has been evaluated in a limited way and has not been widely adopted. The aim of this study was to compare the sensitivity and specificity of inoculation of periprosthetic tissue specimens into blood culture bottles with standard agar and thioglycolate broth culture, applying Bayesian latent class modeling (LCM) in addition to applying the Infectious Diseases Society of America (IDSA) criteria for prosthetic joint infection. This prospective cohort study was conducted over a 9-month period (August 2013 to April 2014) at the Mayo Clinic, Rochester, MN, and included all consecutive patients undergoing revision arthroplasty. Overall, 369 subjects were studied; 117 (32%) met IDSA criteria for prosthetic joint infection, and 82% had late chronic infection. Applying LCM, inoculation of tissues into BCBs was associated with a 47% improvement in sensitivity compared to the sensitivity of conventional agar and broth cultures (92.1 versus 62.6%, respectively); this magnitude of change was similar when IDSA criteria were applied (60.7 versus 44.4%, respectively;P= 0.003). The time to microorganism detection was shorter with BCBs than with standard media (P< 0.0001), with aerobic and anaerobic BCBs yielding positive results within a median of 21 and 23 h, respectively. Results of our study demonstrate that the semiautomated method of periprosthetic tissue culture in blood culture bottles is more sensitive than and as specific as agar and thioglycolate broth cultures and yields results faster.IMPORTANCEProsthetic joint infections are a devastating complication of arthroplasty surgery. Despite this, current microbiological techniques to detect and diagnose infections are imperfect. This study examined a new approach to diagnosing infections, through the inoculation of tissue samples from around the prosthetic joint into blood culture bottles. This study demonstrated that, compared to current laboratory practices, this new technique increased the detection of infection. These findings are important for patient care to allow timely and accurate diagnosis of infection.

Download Full-text

On the Necessity of a Customized Knee Spacer in Peri-Prosthetic Joint Infection Treatment: 3D Numerical Simulation Results

Journal of Personalized Medicine ◽

10.3390/jpm11101039 ◽

2021 ◽

Vol 11 (10) ◽

pp. 1039

Author(s):

Marco Balato ◽

Carlo Petrarca ◽

Vincenzo de Matteo ◽

Marco Lenzi ◽

Enrico Festa ◽

...

Keyword(s):

Ad Hoc ◽

Joint Infection ◽

Revision Arthroplasty ◽

High Morbidity ◽

Virtual Planning ◽

Joint Infections ◽

Prosthetic Joint ◽

Infection Treatment ◽

Prosthetic Joint Infections ◽

Surgical Complexity

Peri-prosthetic joint infections (PJIs) dramatically affect human health, as they are associated with high morbidity and mortality rates. Two-stage revision arthroplasty is currently the gold standard treatment for PJI and consists of infected implant removal, an accurate debridement, and placement of antimicrobial impregnated poly-methyl-metha-acrylate (PMMA) spacer. The use of antibiotic-loaded PMMA (ALPMMA) spacers have showed a success rate that ranges from 85% to 100%. ALPMMA spacers, currently available on the market, demonstrate a series of disadvantages, closely linked to a low propensity to customize, seen as the ability to adapt to the patients’ anatomical characteristics, with consequential increase of surgical complexity, surgery duration, and post-operative complications. Conventionally, ALPMMA spacers are available only in three or four standard sizes, with the impossibility of guaranteeing the perfect matching of ALPMMA spacers with residual bone (no further bone loss) and gap filling. In this paper, a 3D model of an ALPMMA spacer is introduced to evaluate the cause- effect link between the geometric characteristics and the correlated clinical improvements. The result is a multivariable-oriented design able to effectively manage the size, alignment, stability, and the patients’ anatomical matching. The preliminary numerical results, obtained by using an “ad hoc” 3D virtual planning simulator, clearly point out that to restore the joint line, the mechanical and rotational alignment and the surgeon’s control on the thicknesses (distal and posterior thicknesses) of the ALPMMA spacer is mandatory. The numerical simulations campaign involved nineteen patients grouped in three different scenarios (Case N° 1, Case N° 2 and Case N° 3) whose 3D bone models were obtained through an appropriate data management strategy. Each scenario is characterized by a different incidence rate. In particular, the observed rates of occurrence are, respectively, equal to 17% (Case N° 1), 74% (Case N° 2), and 10% (Case N° 3).

Download Full-text

Clinical Experience with Tigecycline in the Treatment of Prosthetic Joint Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.078 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S98-S98

Author(s):

Allison Lastinger ◽

Matthew Dietz ◽

John Guilfoose ◽

Arif R Sarwari

Keyword(s):

Demographic Data ◽

Joint Infection ◽

Treatment Success ◽

The United States ◽

Empiric Therapy ◽

Common Adverse Event ◽

Coagulase Negative Staphylococci ◽

Successful Treatment Outcome ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Abstract Background As the population in the United States ages, the number of people who will require a joint arthroplasty is expected to rise dramatically. The most serious complication of this surgery is prosthetic joint infection (PJI) which can lead to long-term morbidity and even mortality. Biofilms play a major role in these infections, and studies have suggested that tigecycline may work better than other antimicrobials in the setting of biofilms. In this study, we examined our institution’s experience with using tigecycline to treat PJI. Methods This was a retrospective review of all adult patients with PJI treated at West Virginia University from January 2008 to March 2016 who received tigecycline for 50% or greater of the treatment course. Demographic data, rationale for tigecycline use, type of surgery, microbiologic data, outcome and complications were assessed. Failure was defined as need to return to the operating room for an infectious complication or persistent drainage from the joint. Results In total, 34 patients met inclusion criteria. The median age was 65 years, and 62% of the patients were female. The most common reason for tigecycline use was empiric therapy, but other reasons included antimicrobial allergies and resistant organisms. The antimicrobial was used as frontline therapy in 29 cases (85%), and the mean duration of tigecycline therapy was 38 days. The most common organisms isolated were methicillin resistant Staphylococcus aureus (n = 7), coagulase negative Staphylococci (n = 5), and Enterococcus species (n = 4), but 12 cases (35%) were culture negative. Treatment success was documented for 21 cases (62%); though, there was limited follow-up (2 months or less) in four of the successful cases. Nausea and vomiting was the most common adverse event, occurring in three patients. Conclusion Tigecycline is a glycylcycline approved for use in a variety of infections including intra-abdominal and skin soft-tissue infections, but little is known about its use in the treatment of PJI. We found that tigecycline is well tolerated even when given for 6 weeks duration. Twenty-one of the 34 patients (62%) met our definition of successful treatment outcome with tigecycline. More studies are needed to assess tigecycline’s use in the treatment of PJI. Disclosures All authors: No reported disclosures.

Download Full-text

779. Mycobacterium tuberculosis Prosthetic Joint Infections: A Case Series and Literature Review

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.786 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S279-S279

Author(s):

Fabrice Uhel ◽

Grégory Corvaisier ◽

Yves Poinsignon ◽

Catherine Chirouze ◽

Guillaume Béraud ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Literature Review ◽

Joint Infection ◽

Case Series ◽

Revision Arthroplasty ◽

Joint Infections ◽

Prosthesis Retention ◽

Antituberculosis Treatment ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Abstract Background Mycobacterium tuberculosis is a rare cause of prosthetic joint infection (PJI), as most countries with high prevalence of tuberculosis have limited access to arthroplasty. We aimed to characterize the diagnosis, the management, and the outcome of M. tuberculosis PJI. Methods All cases of M. tuberculosis PJI documented in a network of 7 referral centers in France were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire, including diagnosis, management, and outcome. In addition, we performed a systematic literature review using the keywords”prosthetic joint,” and”tuberculosis.” Results During years 1997–2016, we managed 13 patients (8 males, 5 females, median age 79 years [range, 60–86]) with documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to PJI diagnosis was 9 years [0.4–20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6–32]). Nine patients underwent surgery: debridement (n = 4), definitive resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. One patient died of disseminated tuberculosis. The literature review identified 70 additional cases of documented M. tuberculosis PJI, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement and prosthesis retention, 86% (19/22) with revision arthroplasty, and 81% (17/21) with definitive prosthesis resection (NS). Conclusion M. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.This case series and literature review suggest that the paradigms for the management of M. tuberculosis PJI may differ from PJI related to other pathogens, for which surgery is required. Disclosures All authors: No reported disclosures.

Download Full-text

Outcomes and Risk Factors in Prosthetic Joint Infections by multidrug-resistant Gram-negative Bacteria: A Retrospective Cohort Study

Antibiotics ◽

10.3390/antibiotics10030340 ◽

2021 ◽

Vol 10 (3) ◽

pp. 340

Author(s):

Raquel Bandeira da Silva ◽

Mauro José Salles

Keyword(s):

Risk Factors ◽

Treatment Failure ◽

Treatment Outcomes ◽

Revision Arthroplasty ◽

Multidrug Resistant ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Postoperative Hematoma ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Gram-negative bacteria (GNB), including multidrug-resistant (MDR) pathogens, are gaining importance in the aetiology of prosthetic joint infection (PJI). This retrospective observational study identified independent risk factors (RFs) associated with MDR-GNB PJI and their influence on treatment outcomes. We assessed MDR bacteria causing hip and knee PJIs diagnosed at a Brazilian tertiary hospital from January 2014 to July 2018. RFs associated with MDR-GNB PJI were estimated by bivariate and multivariate analyses using prevalence ratios (PRs) with significance at p < 0.05. Kaplan–Meier analysis was performed to evaluate treatment outcomes. Overall, 98 PJI patients were analysed, including 56 with MDR-GNB and 42 with other bacteria. Independent RFs associated with MDR-GNB PJI were revision arthroplasty (p = 0.002), postoperative hematoma (p < 0.001), previous orthopaedic infection (p = 0.002) and early infection (p = 0.001). Extensively drug-resistant GNB (p = 0.044) and comorbidities (p = 0.044) were independently associated with MDR-GNB PJI treatment failure. In sum, MDR-GNB PJI was independently associated with previous orthopaedic surgery, postoperative local complications and pre-existing infections and was possibly related to selective pressure on bacterial skin colonisation by antibiotics prescribed for early PJI. Infections due to MDR-GNB and comorbidities were associated with higher treatment failure rates.

Download Full-text

Comparing the Diagnostic Value of Serum D-Dimer to CRP and IL-6 in the Diagnosis of Chronic Prosthetic Joint Infection

Journal of Clinical Medicine ◽

10.3390/jcm9092917 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2917

Author(s):

Thomas Ackmann ◽

Burkhard Möllenbeck ◽

Georg Gosheger ◽

Jan Schwarze ◽

Tom Schmidt-Braekling ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Joint Infection ◽

Revision Arthroplasty ◽

Preoperative Assessment ◽

Diagnostic Value ◽

Musculoskeletal Infection ◽

Prosthetic Joint ◽

The Individual ◽

Low Sensitivity ◽

D Dimer

Introduction: D-dimer is a diagnostic criterion for periprosthetic joint infection (PJI) of the Musculoskeletal Infection Society (MSIS) in 2018. The aim of this study was to evaluate the serum D-dimer values in comparison to C-reactive protein (CRP) and interleukin-6 (IL-6) for the diagnosis of PJI. Materials and Methods: We included 119 patients (50 women, 69 men; 71 knees, 48 hips) undergoing revision arthroplasty with preoperative assessment of CRP, IL-6, and serum D-dimer. Cases were classified as infected or aseptic based on the MSIS criteria of 2018. Receiver operating curves and Youden’s index were used to define an ideal cut-off value and sensitivity and specificity for the individual parameters, and respective combinations were calculated using cross-tables. Results: The median D-dimer level (2320 vs. 1105 ng/mL; p < 0.001), the median CRP level (4.0 vs. 0.5 mg/dL; p < 0.001), and the median IL-6 level (21.0 vs. 5.0 pg/mL; p < 0.001) were significantly higher in the group of PJI compared to the group with aseptic failure. The calculated optimal cut-off values were 2750 ng/mL (AUC 0.767) for D-dimer, 1.2 mg/dL (AUC 0.914) for CRP, and 10.0 pg/mL (AUC 0.849) for IL-6. D-dimer showed a sensitivity of 38% and specificity of 94%, whereas the CRP and IL-6 had sensitivities of 88% and 76%, and specificities of 87% and 92%, respectively. Conclusion: In comparison with CRP and IL-6, serum D-dimer showed low sensitivity and specificity in our cohort. While CRP and IL-6 combination had the highest sensitivity, a combination of Il-6 and D-dimer or CRP and IL-6 had the highest specificity.

Download Full-text

Sonication Culture of Antimicrobial Agent-Containing Cement Spacers Removed during Staged Revisions for Arthroplasty Infection

Journal of Clinical Microbiology ◽

10.1128/jcm.01483-18 ◽

2018 ◽

Vol 57 (2) ◽

Author(s):

Eric Gomez-Urena ◽

Rafael J. Sierra ◽

Kerryl E. Greenwood-Quiantance ◽

Melissa J. Karau ◽

James M. Steckelberg ◽

...

Keyword(s):

Tissue Culture ◽

Antimicrobial Agent ◽

Persistent Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Similar Proportion ◽

Tissue Cultures ◽

Periprosthetic Tissue ◽

Prosthetic Joint ◽

Sonication Culture

ABSTRACT Diagnosis of persistent infection at the time of reimplantation for staged revision of infected arthroplasties is challenging. Implant sonication culture for the diagnosis of prosthetic joint infection (PJI) has improved sensitivity compared to standard periprosthetic tissue culture. We report our experience with periprosthetic tissue culture and sonication culture of antimicrobial agent-containing cement spacers (ACSs) collected during second stages of staged revisions for arthroplasty infection. We studied 87 ACSs from 66 patients undergoing two-stage revision arthroplasty for PJI submitted for sonication culture, along with conventional periprosthetic tissue cultures. Two or more positive periprosthetic tissue cultures with the same organism were considered a positive tissue culture. For sonication culture, ≥20 CFU of bacteria per 10 ml of sonicate fluid was considered positive. The sensitivity and specificity of periprosthetic tissue and ACS sonication culture in detecting persistent infection, as well as their association with outcome, were assessed. Persistent infection occurred in 26% of cases. Periprosthetic tissue and sonicate fluid culture had specificities of 96.3 and 100% (P = 0.50), respectively, and sensitivities of 31.6 and 26.3% (P = 1.00), respectively, for the diagnosis of persistent infection. Thirteen subjects deemed not to have persistent infection at time of reimplantation and who had negative periprosthetic tissue and sonicate fluid cultures subsequently developed overt infection. Sonication culture of cement spacers identifies a similar proportion of patients with persistent infection during staged revisions, as detected by periprosthetic tissue cultures; both have low sensitivities to detect persistent infection.

Download Full-text

The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive

PLoS ONE ◽

10.1371/journal.pone.0252322 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0252322

Author(s):

Taiana Cunha Ribeiro ◽

Emerson Kiyoshi Honda ◽

Daniel Daniachi ◽

Ricardo de Paula Leite Cury ◽

Cely Barreto da Silva ◽

...

Keyword(s):

Tissue Culture ◽

Diagnostic Criteria ◽

Gold Standard ◽

Joint Infection ◽

Clinical Criterion ◽

Tissue Cultures ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

The Impact ◽

Sonication Culture

Background In the absence of a gold standard criterion for diagnosing prosthetic joint infections (PJI), sonication of the removed implant may provide superior microbiological identification to synovial fluid and peri-implant tissue cultures. The aim of this retrospective study was to assess the role of sonication culture compared to tissue cultures for diagnosing PJI, using different consensus and international guidelines for PJI definition. Methods Data of 146 patients undergoing removal of hip or knee arthroplasties between 2010 and 2018 were retrospectively reviewed. The International Consensus Meeting (ICM-2018), Musculoskeletal Infection Society (MSIS), Infectious Diseases Society of America (IDSA), the European Bone and Joint Infection Society (EBJIS), and a modified clinical criterion, were used to compare the performance of microbiological tests. McNemar´s test and proportion comparison were employed to calculate p-value. Results Overall, 56% (82/146) were diagnosed with PJI using the clinical criteria. Out of these cases, 57% (47/82) tested positive on tissue culture and 93% (76/82) on sonication culture. Applying this clinical criterion, the sensitivity of sonication fluid and tissue cultures was 92.7% (95% CI: 87.1%- 98.3%) and 57.3% (95% CI: 46.6%-68.0%) (p<0.001), respectively. When both methods were combined for diagnosis (sonication and tissue cultures) sensitivity reached 96.3% (95% CI: 91.5%-100%). Sonication culture and the combination of sonication with tissue cultures, showed higher sensitivity rates than tissue cultures alone for all diagnostic criteria (ICM-18, MSIS, IDSA and EBJIS) applied. Conversely, tissue culture provided greater specificity than sonication culture for all the criteria assessed, except for the EBJIS criteria, in which sonication and tissue cultures specificity was 100% and 95.3% (95% CI: 87.8–100%), respectively (p = 0.024). Conclusions In a context where diagnostic criteria available have shortcomings and tissue cultures remain the gold standard, sonication cultures can aid PJI diagnosis, especially when diagnostic criteria are inconclusive due to some important missing data (joint puncture, histology).

Download Full-text

Do Prosthetic Joint Infections Worsen the Functional Ambulatory Outcome of Patients with Joint Replacements? A Retrospective Matched Cohort Study

Antibiotics ◽

10.3390/antibiotics9120872 ◽

2020 ◽

Vol 9 (12) ◽

pp. 872

Author(s):

Isabel Mur ◽

Marcos Jordán ◽

Alba Rivera ◽

Virginia Pomar ◽

José Carlos González ◽

...

Keyword(s):

Cohort Study ◽

Joint Infection ◽

Assistive Device ◽

Matched Cohort ◽

Knee Prostheses ◽

Matched Cohort Study ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Hip Arthroplasties

Objectives: To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. Methods: In a single-hospital retrospectively matched cohort study, each patient with PJI between 2007 and 2016 was matched on age, sex, type of prosthesis and year of implantation with two other patients with uninfected arthroplasties. The definition of a PJI cure included infection eradication, no further surgical procedures, no PJI-related mortality and no suppressive antibiotics. Functional ambulatory status evaluated one year after the last surgery was classified into four simple categories: able to walk without assistance, able to walk with one crutch, able to walk with two crutches, and unable to walk. Patients with total hip arthroplasties (THAs), total knee arthroplasties (TKAs) and partial hip arthroplasties (PHAs) were analysed separately. Results: A total of 109 PJI patients (38 TKA, 41 THA, 30 PHA) and 218 non-PJI patients were included. In a model adjusted for clinically relevant variables, PJI was associated with a higher risk of needing an assistive device for ambulation (vs. walking without aid) among THA (adjusted odds ratio (OR) 3.10, 95% confidence interval (95% CI) 1.26–7.57; p = 0.014) and TKA patients (OR 5.40, 95% CI 2.12–13.67; p < 0.001), and with requiring two crutches to walk or being unable to walk (vs. walking unaided or with one crutch) among PHA patients (OR 3.05, 95% CI 1.01–9.20; p = 0.047). Conclusions: Ambulatory outcome in patients with hip and knee prostheses with postoperative PJI is worse than in patients who do not have PJI.

Download Full-text

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

Journal of Clinical Medicine ◽

10.3390/jcm8122113 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2113 ◽

Cited By ~ 2

Author(s):

Deroche ◽

Bémer ◽

Valentin ◽

Jolivet-Gougeon ◽

Tandé ◽

...

Keyword(s):

Joint Infection ◽

Antimicrobial Treatment ◽

Microbiological Diagnosis ◽

Joint Infections ◽

Time To Positivity ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Two Samples ◽

The Right ◽

Polymicrobial Infections

Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.

Download Full-text