scholarly journals Shoulder Joint Infections with Negative Culture Results: Clinical Characteristics and Treatment Outcomes

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Mohamed Attia Abdou ◽  
Ahreum Jo ◽  
Ik-Sun Choi ◽  
Chae-Jin Iim ◽  
Hyeng-Kyu Park ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Shoulder Joint ◽  
Clinical Characteristics ◽  
Demographic Data ◽  
Multiple Logistic Regression Analysis ◽  
Negative Results ◽  
Joint Infections ◽  
Functional Scores ◽  
Culture Positive ◽  
Culture Negative

Background. The incidence of septic arthritis of the shoulder joint is increasing as the population ages. The prevalence of shoulder infection is also increasing because of the growing use of arthroscopy and expansion of procedures in the shoulder. However, cultures do not always identify all microorganisms, even in symptomatic patients. The incidence of negative cultures ranges from 0% to 25%. Few studies have reported clinical features and treatment outcomes of culture-negative shoulder infections. This cohort study addresses culture-negative shoulder joint infections in nonarthroplasty patients. This study aimed to compare clinical characteristics and treatment outcomes of patients with culture-negative results to those with culture-positive results. Our hypothesis was that culture-negative infections would have more favorable outcomes than culture-positive infections. Methods. We retrospectively reviewed data of 36 patients (17 culture-negative and 19 culture-positive) with shoulder infections between June 2004 and March 2015. The minimum follow-up duration was 1.2 years (mean, 5 ± 3.8 years; range, 1.2-11 years). We assessed preoperative demographic data and characteristics, laboratory markers, imaging and functional scores, intraoperative findings, and postoperative findings of both groups. Results. Culture-negative patients (17/36, 47.2%) had a significantly lower occurrence of repeated surgical debridement (culture-negative vs. culture-positive: 1.2 ± 0.4 vs. 2.4 ± 1.7, p = 0.002) without osteomyelitis. In the multiple logistic regression analysis, the presence of osteomyelitis [odds ratio (OR) = 9.7, 95% confidence interval (CI): 1.0-91.8, p=0.04)] and the number of surgical debridements (OR = 5.3, 95% CI: 1.3-21.6, p=0.02) were significantly associated with culture-positive infections. Conclusions. Culture-negative infections without osteomyelitis are less severe than culture-positive infections. Culture-negative infections can be controlled more easily and are not necessarily a negative prognostic factor for shoulder joint infections.

scholarly journals Clinical Characteristics and Risk Factors for Culture-Negative Periprosthetic Joint Infections

2021 ◽  
Author(s):  
Shintaro Watanabe ◽  
Naomi Kobayashi ◽  
Akito Tomoyama ◽  
Hyonmin Choe ◽  
Etsuko Yamazaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clinical Characteristics ◽  
Treatment Success ◽  
Multivariate Logistic Regression Analysis ◽  
Joint Infections ◽  
Wbc Count ◽  
Culture Positive ◽  
Culture Negative ◽  
Low Serum

Abstract Background Culture-negative periprosthetic joint infections (PJIs) can complicate diagnosis and management of PJI. This study aimed to identify risk factors for culture-negative PJI and differences in clinical characteristics between culture-positive and culture-negative PJI group. Methods This retrospective, cross-sectional study evaluated PJI cases obtained between January 2013 and October 2019 at our institution. These PJI cases were divided into culture-positive and culture-negative groups and then compared. The demographics, laboratory findings, and details of patient’s clinical characteristics were investigated. Univariate and multivariate logistic regression analysis were performed to investigate risk factors for culture-negative PJI. Results A total of 109 PJI cases were included in the analysis: 82 (75%) culture-positive and 27 (25%) culture-negative. The mean serum white blood cell (WBC) count, C-reactive protein level, erythrocyte sedimentation rate in the culture-negative group were significantly lower than those in the culture-positive group (p < 0.05). There were no significant differences between the two groups regarding history of prior antibacterial administration or treatment success rates. Multivariate analysis identified a low serum WBC count as a risk factor for culture-negative PJI (odds ratio = 0.78; 95% confidence interval [CI] = 0.63–0.97; p = 0.027). Conclusions A low serum WBC count is a risk factor for culture-negative PJI, but prior antimicrobial therapy is not. The results suggest that PJI cases with lower levels of systemic inflammation are likely to be culture-negative; therefore, the possibility of a culture-negative result should be considered in suspected cases of PJI with low inflammatory markers, regardless of prior antibiotic exposure.

scholarly journals Clinical characteristics and risk factors for culture-negative periprosthetic joint infections

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Shintaro Watanabe ◽  
Naomi Kobayashi ◽  
Akito Tomoyama ◽  
Hyonmin Choe ◽  
Etsuko Yamazaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clinical Characteristics ◽  
Treatment Success ◽  
Multivariate Logistic Regression Analysis ◽  
Joint Infections ◽  
Wbc Count ◽  
Culture Positive ◽  
Culture Negative ◽  
Low Serum

Abstract Background Culture-negative periprosthetic joint infections (PJIs) can complicate diagnosis and management of PJI. This study aimed to identify risk factors for culture-negative PJI and differences in clinical characteristics between culture-positive and culture-negative PJI group. Methods This retrospective, cross-sectional study evaluated PJI cases obtained between January 2013 and October 2019 at our institution. These PJI cases were divided into culture-positive and culture-negative groups and then compared. The demographics, laboratory findings, and details of patient’s clinical characteristics were investigated. Univariate and multivariate logistic regression analysis were performed to investigate risk factors for culture-negative PJI. Results A total of 109 PJI cases were included in the analysis: 82 (75%) culture-positive and 27 (25%) culture-negative. The mean serum white blood cell (WBC) count, C-reactive protein level, and erythrocyte sedimentation rate in the culture-negative group were significantly lower than those in the culture-positive group (p < 0.05). There were no significant differences between the two groups regarding history of prior antibacterial administration or treatment success rates. Multivariate analysis identified a low serum WBC count as a risk factor for culture-negative PJI (odds ratio = 0.78; 95% confidence interval [CI] = 0.63–0.97; p = 0.027). Conclusions A low serum WBC count is a risk factor for culture-negative PJI, but prior antimicrobial therapy is not. The results suggest that PJI cases with lower levels of systemic inflammation are likely to be culture-negative; therefore, the possibility of a culture-negative result should be considered in suspected cases of PJI with low inflammatory markers, regardless of prior antibiotic exposure.

scholarly journals Clinical Characteristics and Risk Factors for Culture-Negative Periprosthetic Joint Infections

2020 ◽  
Author(s):  
Shintaro Watanabe ◽  
Naomi Kobayashi ◽  
Akito Tomoyama ◽  
Hyonmin Choe ◽  
Etsuko Yamazaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clinical Characteristics ◽  
Treatment Success ◽  
Multivariate Logistic Regression Analysis ◽  
Lower Serum ◽  
Joint Infections ◽  
Wbc Count ◽  
Culture Positive ◽  
Culture Negative

Abstract Background: Culture-negative periprosthetic joint infections (PJIs) can complicate diagnosis and management of PJI. This study aimed to identify risk factors for culture-negative PJI and differences in clinical characteristics between culture-positive and culture-negative PJI group. Methods: This retrospective, cross-sectional study evaluated PJI cases obtained between January 2013 and October 2019 at our institution. These PJI cases were divided into culture-positive and culture-negative groups and then compared. The demographics, laboratory findings, and details of patient’s clinical characteristics were investigated. Univariate and multivariate logistic regression analysis were performed to investigate risk factors for culture-negative PJI.Results: A total of 109 PJI cases were included in the analysis: 82 (75%) culture-positive and 27 (25%) culture-negative. The mean serum white blood cell (WBC) count, C-reactive protein level, erythrocyte sedimentation rate in the culture-negative group were significantly lower than those in the culture-positive group (p < 0.05). There were no significant differences between the two groups regarding history of prior antibacterial administration or treatment success rates. Multivariate analysis identified a lower serum WBC count as a risk factor for culture-negative PJI (odds ratio = 0.78; 95% confidence interval [CI] = 0.63–0.97; p = 0.027).Conclusions: A lower serum WBC count is a risk factor for culture-negative PJI, but prior antimicrobial therapy is not. The results suggest that PJI cases with lower levels of systemic inflammation are likely to be culture-negative; therefore, the possibility of a culture-negative result should be considered in suspected cases of PJI with low inflammatory markers, regardless of prior antibiotic exposure.

scholarly journals Clinical Characteristics and Risk Factors for Culture-Negative Periprosthetic Joint Infections

2020 ◽  
Author(s):  
Shintaro Watanabe ◽  
Naomi Kobayashi ◽  
Akito Tomoyama ◽  
Hyonmin Choe ◽  
Etsuko Yamazaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clinical Characteristics ◽  
Treatment Success ◽  
Multivariate Logistic Regression Analysis ◽  
Joint Infections ◽  
Wbc Count ◽  
Culture Positive ◽  
Culture Negative ◽  
Low Serum

Abstract Background: Culture-negative periprosthetic joint infections (PJIs) can complicate diagnosis and management of PJI. This study aimed to identify risk factors for culture-negative PJI and differences in clinical characteristics between culture-positive and culture-negative PJI group. Methods: This retrospective, cross-sectional study evaluated PJI cases obtained between January 2013 and October 2019 at our institution. These PJI cases were divided into culture-positive and culture-negative groups and then compared. The demographics, laboratory findings, and details of patient’s clinical characteristics were investigated. Univariate and multivariate logistic regression analysis were performed to investigate risk factors for culture-negative PJI.Results: A total of 109 PJI cases were included in the analysis: 82 (75%) culture-positive and 27 (25%) culture-negative. The mean serum white blood cell (WBC) count, C-reactive protein level, erythrocyte sedimentation rate in the culture-negative group were significantly lower than those in the culture-positive group (p < 0.05). There were no significant differences between the two groups regarding history of prior antibacterial administration or treatment success rates. Multivariate analysis identified a low serum WBC count as a risk factor for culture-negative PJI (odds ratio = 0.78; 95% confidence interval [CI] = 0.63–0.97; p = 0.027).Conclusions: A low serum WBC count is a risk factor for culture-negative PJI, but prior antimicrobial therapy is not. The results suggest that PJI cases with lower levels of systemic inflammation are likely to be culture-negative; therefore, the possibility of a culture-negative result should be considered in suspected cases of PJI with low inflammatory markers, regardless of prior antibiotic exposure.

scholarly journals Comparison Between Culture-Positive and Culture-Negative Septic Shock in Emergency Department Patients

2022 ◽  
Author(s):  
Yen-Chang Huang ◽  
Chi-Chieh Hung ◽  
Yong-Ye Yang ◽  
Tsung-Han Wang ◽  
Yin-Chou Hsu
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Clinical Characteristics ◽  
Management Strategies ◽  
Intensive Care Unit Care ◽  
Antibiotic Administration ◽  
Retrospective Case ◽  
Emergency Department Patients ◽  
Culture Positive ◽  
Culture Negative

Abstract Culture results in patients with septic shock affect their management strategies. Our study aimed to compare the clinical characteristics and outcomes of patients with culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS). A single-center, retrospective, case-control study included adult patients diagnosed with septic shock in the emergency department between January 1, 2019 and March 31, 2020. They were divided into CNSS and CPSS groups based on their culture results. Patients with CPSS (63.7%, 311/488) and CNSS (36.3%, 177/488) were identified. The CPSS and CNSS groups had comparable clinical outcomes, including mechanical ventilation (29.6% vs. 32.8%, p = 0.46), renal replacement therapy (19.3% vs. 23.2%, p = 0.31), intensive care unit care (51.8% vs. 45.2%, p = 0.16), 30-day (35.7% vs. 36.7%, p = 0.82) and in-hospital mortality (39.5% vs. 41.8%, p = 0.63). The duration (13 [8−19] vs. 16 [10−23], days, p = 0.04) and de-escalation timing (5 [2−10] vs. 9 [7−12], day, p = 0.02) of antibiotic administration in the CNSS group was significantly shorter and earlier than in the CPSS group. Patients with CNSS and CPSS had similar clinical characteristics and adverse outcome proportions. Physicians can evaluate the feasibility of early de-escalation or discontinuation of antibiotic administration in CNSS patients with clinical improvement.

Contribution of Xpert MTB/RIF to clinical diagnosis in adolescents with tuberculosis in Rio de Janeiro, Brazil

2019 ◽  
Vol 23 (10) ◽  
pp. 1115-1121 ◽  
Author(s):  
M. C. B. Oliveira ◽  
C. C. Sant'Anna ◽  
R. R. Luiz ◽  
E. C. C. Soares ◽  
A. L. Kritski
Keyword(s):  
Treatment Outcomes ◽  
Clinical Diagnosis ◽  
Rio De Janeiro ◽  
Care Process ◽  
Sample Collection ◽  
Negative Results ◽  
Group 3 ◽  
Group 2 ◽  
Culture Negative ◽  
Group 1

SETTING: Rio de Janeiro, RJ, Brazil, a high tuberculosis (TB) burden city.OBJECTIVE: To compare the sociodemographics, clinical characteristics, care process indicators (CPIs) and treatment outcomes among adolescents with pulmonary TB (PTB) and those with PTB + extrapulmonary TB (EPTB), who underwent testing with Xpert® and sputum culture.DESIGN: This was a retrospective study of data from three national databases from 2014 to 2016 of adolescents (aged 10–18 years) residing and notified in Rio de Janeiro City. Three groups were identified according to their Xpert and culture results: Group 1, Xpert- and culture-positive; Group 2, Xpert-positive and culture-negative; and Group 3, Xpert- and culture-negative. Study CPIs were as follows: the time between ‘sample collection and Xpert result release', ‘sample collection and treatment initiation' and ‘notification and treatment outcome'.RESULTS: Of 258 adolescents included in the study, 223 (86.4%) were in Group 1, 20 (7.8%) in Group 2 and 15 (5.8%) in Group 3. Groups 1 and 2 had a similar profile. Compared to Group 1, Group 3 had a higher proportion of HIV-positive cases (21.4% vs. 3.0%, P = 0.016), adolescents with a hospital diagnosis (53.3% vs. 7.6%, P < 0.001), and PTB + EPTB cases (20% vs. 0.4%; P < 0.001). There were no statistically significant differences in CPIs or treatment outcomes.CONCLUSION: The clinical diagnosis was decisive in more critical or complex patients, despite Xpert-negative results.

scholarly journals Do Culture-Negative Periprosthetic Joint Infections Have a Worse Outcome Than Culture-Positive Periprosthetic Joint Infections? A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Marie Reisener ◽  
Carsten Perka
Keyword(s):  
Systematic Review ◽  
Treatment Strategies ◽  
Diagnosis And Treatment ◽  
Cochrane Library ◽  
Two Stage ◽  
Level Of Evidence ◽  
Clinical Issue ◽  
Joint Infections ◽  
Culture Positive ◽  
Culture Negative

Background. Culture-negative periprosthetic joint infections (CN PJI) have not been well studied, and due to the lack of consensus on PJI, especially with culture-negative infections, there are considerable uncertainties. Due to the challenging clinical issue of CN PJI the aim of this systematic review is to describe incidence, diagnosis, and treatment outcomes based on the current literature on CN PJI.Hypothesis.The review is designed to assess the formal hypothesis that CN PJI of the hip and knee have a poorer outcome when compared with culture-positive ones.Study Design.It is systematic review with level of evidence 3.Methods.EMBASE, MEDLINE, and the Cochrane Library were searched electronically in January 2018. All studies regarding CN PJI of the hip or knee published in English or German with a minimum of 10 patients were included. Afterwards, the authors performed a descriptive analysis of diagnosis and treatment outcome.Result.Eight studies were identified that met the inclusion criteria. The incidence of CN PJI in the hip or knee ranged from 7% to 42 %. The included studies were pooled to give an overall incidence rate estimate of 11 % [95% confidence interval (CI): 10-12] based on a random-effects model. The most common surgical intervention was the two-stage revision of prosthesis with 283 patients. Postoperatively, the majority of patients received vancomycin as the antibiotic treatment, alone or in combination with other antibiotics. The rate of succesfully treated infections varied from 85% to 95 % in all included studies. The two-stage exchange arthroplasty had the best outcome, based on the infection-free survival rate of 95%, five years after treatment.Conclusions.We conclude that CN PJI have the same or even better results than culture-positive infections. Nonetheless, a standardized diagnostic protocol and evidence-based treatment strategies for CN PJI should be implemented for further studies.

scholarly journals Lack of Additional Diagnostic Yield of 16s rRNA Gene PCR for Prosthetic Joint Infections

2019 ◽  
Vol 4 (2) ◽  
pp. 224-228
Author(s):  
Michael A Lane ◽  
Neeraja Ganeshraj ◽  
Alice Gu ◽  
David K Warren ◽  
Carey-Ann D Burnham
Keyword(s):  
16S Rrna ◽  
16S Rrna Gene ◽  
Diagnostic Yield ◽  
Diagnostic Tools ◽  
Rrna Gene ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Culture Positive ◽  
Culture Negative

Abstract Introduction Medical management of prosthetic joint infections (PJIs) relies on the identification of causative organisms through traditional culture-based approaches to guide therapy. However, diagnosis of many PJIs remains challenging, with many clinically apparent infections remaining culture-negative. Molecular diagnostics have the potential to increase diagnostic yield, particularly among culture-negative PJIs. Methods Bone, tissue, or synovial fluid from patients with clinically identified PJIs were collected for inclusion in this study. Samples were assessed with traditional cultures and classified as culture-positive or -negative after 48 h. Samples subsequently underwent a Staphylococcus aureus-/Kingella kingae-specific PCR followed by a 16s rRNA gene PCR. Results A total of 77 unique patients with clinically identified PJIs contributed a total of 89 samples for inclusion in the study. There were 54 culture-negative and 35 culture-positive samples evaluated. The sensitivity and specificity of S. aureus PCR in culture-positive samples was 57.1% (95% CI, 34.1%–78.1%) and 92.9% (95% CI, 66.1%–98.9%), respectively. Among culture-positive samples, 16s rRNA gene PCR correctly identified 3 of 21 (14.3%) samples with S. aureus and 2 of 5 (40%) samples with Streptococcus spp. All molecular tests were negative in those with clinically identified, culture-negative PJI. Conclusions Our study suggests that these diagnostic tools have a limited role in PJI diagnosis.

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