The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: a Systematic Review

ABSTRACTObtaining reliable cultures during revision arthroplasty is important to adequately diagnose and treat a prosthetic joint infection (PJI). The influence of antimicrobial prophylaxis on culture results remains unclear. Since withholding prophylaxis increases the risk for surgical site infections, clarification on this topic is critical. A systematic review was performed with the following research question: in patients who undergo revision surgery of a prosthetic joint, does preoperative antimicrobial prophylaxis affect the culture yield of intraoperative samples in comparison with nonpreoperative antimicrobial prophylaxis? Seven articles were included in the final analysis. In most studies, standard diagnostic culture techniques were used. In patients with a PJI, pooled analysis showed a culture yield of 88% (145/165) in the prophylaxis group versus 95% (344/362) in the nonprophylaxis group (P= 0.004). Subanalysis of patients with chronic PJIs showed positive cultures in 88% (78/89) versus 91% (52/57), respectively (P= 0.59). In patients with a suspected chronic infection, a maximum difference of 4% in culture yield between the prophylaxis and nonprophylaxis groups was observed. With the use of standard culture techniques, antimicrobial prophylaxis seems to affect cultures in a minority of patients. Along with the known risk of surgical site infections due to inadequate timing of antimicrobial prophylaxis, we discourage the postponement of prophylaxis until tissue samples are obtained in revision surgery. Future studies are necessary to conclude whether the small percentage of false-negative cultures after prophylaxis can be further reduced with the use of more-sensitive culture techniques, like sonication.

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Optimal Periprosthetic Tissue Specimen Number for Diagnosis of Prosthetic Joint Infection

Journal of Clinical Microbiology ◽

10.1128/jcm.01914-16 ◽

2016 ◽

Vol 55 (1) ◽

pp. 234-243 ◽

Cited By ~ 34

Author(s):

Trisha N. Peel ◽

Tim Spelman ◽

Brenda L. Dylla ◽

John G. Hughes ◽

Kerryl E. Greenwood-Quaintance ◽

...

Keyword(s):

Tissue Culture ◽

Blood Culture ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Periprosthetic Tissue ◽

Culture Bottle ◽

Culture Techniques ◽

Prosthetic Joint ◽

Tissue Specimens

ABSTRACTWe recently demonstrated improved sensitivity of prosthetic joint infection (PJI) diagnosis using an automated blood culture bottle system for periprosthetic tissue culture [T. N. Peel et al., mBio 7(1):e01776-15, 2016,https://doi.org/10.1128/mBio.01776-15]. This study builds on the prior research by examining the optimal number of periprosthetic tissue specimens required for accurate PJI diagnosis. Current guidelines recommend five to six, which is impractical. We applied Bayesian latent class modeling techniques for estimating diagnostic test properties of conventional culture techniques (aerobic and anaerobic agars and thioglycolate broth) compared to inoculation into blood culture bottles. Conventional, frequentist receiver operating characteristic curve analysis was conducted as a sensitivity analysis. The study was conducted at Mayo Clinic, Rochester, MN, from August 2013 through April 2014 and included 499 consecutive patients undergoing revision arthroplasty from whom 1,437 periprosthetic tissue samples were collected and processed. For conventional periprosthetic tissue culture techniques, the greatest accuracy was observed when four specimens were obtained (91%; 95% credible interval, 77 to 100%), whereas when using inoculation of periprosthetic tissues into blood culture bottles, the greatest accuracy of diagnosis was observed when three specimens were cultured (92%; 95% credible intervals, 79 to 100%). Results of this study show that the greatest accuracy of PJI diagnosis is obtained when three periprosthetic tissue specimens are obtained and inoculated into blood culture bottles or four periprosthetic tissue specimens are obtained and cultured using standard plate and broth cultures. Increasing the number of specimens to five or more, per current recommendations, does not improve accuracy of PJI diagnosis.

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Impact of Prior Intra-articular Injections on the Risk of Prosthetic Joint Infection Following Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.737529 ◽

2021 ◽

Vol 8 ◽

Author(s):

Fei Nie ◽

Wei Li

Keyword(s):

Systematic Review ◽

Prosthetic Joint Infection ◽

Total Joint Arthroplasty ◽

Meta Analysis ◽

Joint Infection ◽

Joint Arthroplasty ◽

Injection Group ◽

Prosthetic Joint ◽

Increased Risk ◽

The Impact

Objective: The current review was designed to assess the impact of prior intra-articular injections on the risk of prosthetic joint infection (PJI) in patients undergoing total joint arthroplasty (TJA) with a focus on the timing of injection before surgery.Methods: The databases of PubMed, Embase and Google Scholar were searched up to 15th June 2021. All studies comparing the incidence of PJI with and without prior intra-articular injections were included. Risk ratios (RR) with 95% confidence intervals were calculated for PJI.Results: Nineteen studies were included. Both corticosteroids and hyaluronic acid injections were used before TJA in the included studies. Overall, comparing 127,163 patients with prior intra-articular injections and 394,104 patients without any injections, we noted a statistically significant increased risk of PJI in the injection group (RR 1.24 95% CI: 1.11, 1.38 I2 = 48% p = 0.002). On subgroup analysis, there was a statistically significant increased risk of PJI in the injection group in studies where intra-articular injections were administered <12 months before surgery (RR 1.18 95% CI: 1.10, 1.27 I2 = 7% p < 0.00001). Furthermore, on meta-analysis, we noted non-significant but increased risk of PJI when injections were administered 1 month (RR 1.47 95% CI: 0.88, 2.46 I2 = 77% p = 0.14), 0–3 months (RR 1.22 95% CI: 0.96, 1.56 I2 = 84% p = 0.11), and 3–6 months (RR 1.16 95% CI: 0.99, 1.35 I2 = 49% p = 0.06) before surgery.Conclusion: Our results indicate that patients with prior intra-articular injections have a small but statistically significant increased risk of PJI after TJA. Considering that PJI is a catastrophic complication with huge financial burden, morbidity and mortality; the clinical significance of this small risk cannot be dismissed. The question of the timing of injections and the risk of PJI still remains and can have a significant impact on the decision making.Systematic Review Registration: PROSPERO: CRD42021258297.

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FDG-PET for diagnosing prosthetic joint infection: systematic review and metaanalysis

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-008-0887-x ◽

2008 ◽

Vol 35 (11) ◽

pp. 2122-2132 ◽

Cited By ~ 99

Author(s):

Thomas C. Kwee ◽

Robert M. Kwee ◽

Abass Alavi

Keyword(s):

Systematic Review ◽

Prosthetic Joint Infection ◽

Fdg Pet ◽

Joint Infection ◽

Prosthetic Joint

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Prosthetic Joint Infection After Dental Work: Is the Correct Prophylaxis Being Prescribed? A Systematic Review

Arthroplasty Today ◽

10.1016/j.artd.2020.11.007 ◽

2021 ◽

Vol 7 ◽

pp. 69-75

Author(s):

Richard M. Danilkowicz ◽

Anne M. Lachiewicz ◽

Daniel J. Lorenzana ◽

Karen D. Barton ◽

Paul F. Lachiewicz

Keyword(s):

Systematic Review ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Prosthetic Joint ◽

Dental Work

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The diagnostic value of routine preliminary biopsy in diagnosing late prosthetic joint infection after hip and knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.102b3.bjj-2019-0684.r1 ◽

2020 ◽

Vol 102-B (3) ◽

pp. 329-335 ◽

Cited By ~ 4

Author(s):

Bernd Fink ◽

Philipp Schuster ◽

Rüdiger Braun ◽

Eli Tagtalianidou ◽

Michael Schlumberger

Keyword(s):

Antibiotic Therapy ◽

Knee Arthroplasty ◽

Prosthetic Joint Infection ◽

Revision Surgery ◽

Predictive Value ◽

Joint Infection ◽

Diagnostic Value ◽

Tissue Samples ◽

Musculoskeletal Infection ◽

Prosthetic Joint

Aims Biopsy of the periprosthetic tissue is an important diagnostic tool for prosthetic joint infection (PJI) as it enables the detection of the responsible microorganism with its sensitivity to antibiotics. We aimed to investigate how often the bacteria identified in the tissue analysis differed between samples obtained from preoperative biopsy and intraoperative revision surgery in cases of late PJI; and whether there was a therapeutic consequence. Methods A total of 508 patients who required revision surgery of total hip arthroplasty (THA) (n = 231) or total knee arthroplasty (TKA) (n = 277) because of component loosening underwent biopsy before revision surgery. The tissue samples collected at biopsy and during revision surgery were analyzed according to the criteria of the Musculoskeletal Infection Society (MSIS). Results In total, 178 (113 THA, 65 TKA) were classified as infected. The biopsy procedure had a sensitivity of 93.8%, a specificity of 97.3%, a positive predictive value (PPV) of 94.9%, a negative predictive value (NPV) of 96.7%, and an accuracy of 96.1%. Of the 178 infected patients, 26 showed a difference in the detected bacteria from the biopsy and the revision surgery (14.6%). This difference required a change to antibiotic therapy in only two cases (1.1%). Conclusion Biopsy is a useful tool to diagnose PJI, but there may be a difference in the detected bacteria between the biopsy and revision surgery. However, this did not affect the choice of antibiotic therapy in most cases, rendering the clinical relevance of this phenomenon as low. Cite this article: Bone Joint J 2020;102-B(3):329–335

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Health Care Needs and Support for Patients Undergoing Treatment for Prosthetic Joint Infection following Hip or Knee Arthroplasty: A Systematic Review

PLoS ONE ◽

10.1371/journal.pone.0169068 ◽

2017 ◽

Vol 12 (1) ◽

pp. e0169068 ◽

Cited By ~ 13

Author(s):

Setor K. Kunutsor ◽

Andrew D. Beswick ◽

Tim J. Peters ◽

Rachael Gooberman-Hill ◽

Michael R. Whitehouse ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Knee Arthroplasty ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Health Care Needs ◽

Care Needs ◽

Prosthetic Joint

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Deep prosthetic joint infection: a qualitative study of the impact on patients and their experiences of revision surgery

BMJ Open ◽

10.1136/bmjopen-2015-009495 ◽

2015 ◽

Vol 5 (12) ◽

pp. e009495 ◽

Cited By ~ 47

Author(s):

Andrew J Moore ◽

Ashley W Blom ◽

Michael R Whitehouse ◽

Rachael Gooberman-Hill

Keyword(s):

Qualitative Study ◽

Prosthetic Joint Infection ◽

Revision Surgery ◽

Joint Infection ◽

Prosthetic Joint ◽

The Impact

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Successful Clinical Use of Daptomycin-Impregnated Bone Cement in Two-Stage Revision Hip Surgery for Prosthetic Joint Infection

Annals of Pharmacotherapy ◽

10.1345/aph.1r486 ◽

2013 ◽

Vol 47 (1) ◽

pp. e2-e2 ◽

Cited By ~ 13

Author(s):

Nicholas J Cortes ◽

John M Lloyd ◽

Leszek Koziol ◽

Lawrence O'Hara

Keyword(s):

Bone Cement ◽

Prosthetic Joint Infection ◽

Revision Surgery ◽

Past History ◽

Joint Infection ◽

Pmma Bone Cement ◽

Prosthetic Joint ◽

History Of

OBJECTIVE To describe the safe and successful use of daptomycin-impregnated polymethyl methacrylate (PMMA) bone cement in the treatment of a case of recurrent prosthetic joint infection in a patient with multiple antibiotic allergies and past colonization with multiply antibiotic-resistant organisms. CASE SUMMARY A 79-year-old female had a history of chronic recurrent left prosthetic hip infection. The patient had confirmed allergies to multiple antibiotics and a past history of colonization with methicillin-resistant Staphylococcus aureus. At first-stage revision surgery, the infected prosthesis was removed and samples were sent for microbiologic culture. A spacer device was fashioned, with incorporation of daptomycin and gentamicin into the PMMA bone cement at a concentration of 5% w/w for each antibiotic. Systemic daptomycin and gentamicin were administered postoperatively for 14 days. Propionibacterium acnes was isolated from deep-tissue specimens. The patient made excellent postoperative progress and was discharged after 2 weeks. Second-stage revision surgery was performed at 6 months, with no signs of persistent infection. She remained well, pain free, and mobilizing independently 2 years later. DISCUSSION Daptomycin, a cyclic lipopeptide antibiotic, is approved for systemic treatment of endocarditis and skin and soft tissue infections. In vitro data demonstrate acceptable drug elution from and tensile strength of daptomycin-impregnated PMMA bone cement; however, clinical data are lacking. In our patient's case, the cement formulation was well tolerated, with no adverse effects detected, and demonstrated adequate mechanical strength in vivo. Infection with P. acnes, an unusual pathogen, was successfully treated. Further clinical studies are required to assess the efficacy of daptomycin-impregnated cement in infection with more typical pathogens, such as S. aureus. CONCLUSIONS Daptomycin impregnation of PMMA bone cement may be an option in cases in which patient or pathogen factors preclude use of routinely incorporated agents.

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