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

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.

scholarly journals Two-stage revision for the culture-negative infected total hip arthroplasty

2018 ◽  
Vol 100-B (1_Supple_A) ◽  
pp. 3-8 ◽  
Author(s):  
M. S. Ibrahim ◽  
H. Twaij ◽  
F. S. Haddad
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Similar Rate ◽  
Two Stage ◽  
Total Hip ◽  
Significant Difference ◽  
Complex Culture ◽  
Culture Positive ◽  
Culture Negative

Aims Periprosthetic joint infection (PJI) remains a challenging complication following total hip arthroplasty (THA). It is associated with high levels of morbidity, mortality and expense. Guidelines and protocols exist for the management of culture-positive patients. Managing culture-negative patients with a PJI poses a greater challenge to surgeons and the wider multidisciplinary team as clear guidance is lacking. Patients and Methods We aimed to compare the outcomes of treatment for 50 consecutive culture-negative and 50 consecutive culture-positive patients who underwent two-stage revision THA for chronic infection with a minimum follow-up of five years. Results There was no significant difference in the outcomes between the two groups of patients, with a similar rate of re-infection of 6%, five years post-operatively. Culture-negative PJIs were associated with older age, smoking, referral from elsewhere and pre-operative antibiotic treatment. The samples in the culture-negative patients were negative before the first stage (aspiration), during the first-stage (implant removal) and second-stage procedures (re-implantation). Conclusion Adherence to strict protocols for selecting and treating culture-negative patients with a PJI using the same two-stage revision approach that we employ for complex culture-positive PJIs is important in order to achieve control of the infection in this difficult group of patients. Cite this article: Bone Joint J 2018;(1 Supple A)100-B:3–8.

scholarly journals Short- and medium-term clinical outcomes of culture-negative and culture-positive periprosthetic joint infection

2020 ◽  
Author(s):  
Zhiyang Xu ◽  
Yuanqing Cai ◽  
Jian Mei ◽  
Xinyu Fang ◽  
Zida Huang ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Outcomes ◽  
Periprosthetic Joint Infection ◽  
Periprosthetic Infection ◽  
Joint Infection ◽  
Joint Involvement ◽  
Significant Difference ◽  
Underlying Diseases ◽  
Culture Positive ◽  
Culture Negative

Abstract Background:Periprosthetic joint infection(PJI)，as a complication of Total joint arthroplasty, is not uncommon nowdays.There are many treatments and the basic one is the application of antibiotics according to the culture results of synovial fluid or tissue specimens.Though many reasearchs have been done about the results of those treatments，but the differences of the effectiveness between culture-negative periprosthetic infection(CN PJI) and culture-positive periprosthetic infection(CP PJI) still remain unknow.So we conduct this study to compare the clinical outcomes of CN PJI with CP PJI.Methods: The clinical data of 77 patients with prosthetic infections were collected retrospectively. The mean follow-up time was 29.2 months (12-76 months). The remission rates of CN PJI and CP PJI were compared. The effects of the culture results on the curative effect were further compared by survival analysis. The correlations between sex, age, underlying diseases, sinus, disease course, joint involvement, surgical strategy, culture results and clinical outcomes were further analyzed by logistic regression.Results: In total, there were 24 cases of CN PJI, with an incidence of 29.63%. The overall success rate of CN PJI was 86.4% (19/22)，and overall success rate of CP PJI was 87.5% (42/48). There was no significant difference in the success rate between CN PJI and CP PJI. The incidence of antibiotic-related complications for CN PJI was significant higher than that for CP PJI, with 58.3% for CN PJI and 11.3% for CP PJI, respectively.Conclusion: CN PJI was treated according to the strict standards for the diagnosis and treatment, and the success rate of treatment for CN PJI was similar to that for CP PJI. The incidence of antibiotic-related complications from CN PJI was higher than that from CP PJI.

scholarly journals Two-stage revision for periprosthetic joint infection of the hip: Culture-negative versus culture-positive infection

2018 ◽  
Vol 15 (2) ◽  
pp. 391-395
Author(s):  
Asep Santoso ◽  
Kyung-Soon Park ◽  
Young-Rok Shin ◽  
Hong-Yeol Yang ◽  
Ik-Sun Choi ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Two Stage ◽  
Culture Positive ◽  
Culture Negative

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

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.

scholarly journals Short- and medium-term clinical outcomes of culture-negative and culture-positive periprosthetic joint infection

2019 ◽  
Author(s):  
Zhiyang Xu ◽  
Yuanqing Cai ◽  
Xinyu Fang ◽  
Zida Huang ◽  
Chaofan Zhang ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Outcomes ◽  
Periprosthetic Infection ◽  
Joint Infection ◽  
Joint Involvement ◽  
Significant Difference ◽  
Underlying Diseases ◽  
Culture Positive ◽  
Culture Negative

Abstract Purpose The purpose of this study was to compare the clinical outcomes of culture-negative periprosthetic infection (CN PJI) with those of culture-positive periprosthetic infection (CP PJI).Methods The clinical data of 77 patients with prosthetic infections were collected retrospectively. The mean follow-up time was 29.2 months (12-76 months). The remission rates of CN PJI and CP PJI were compared. The effects of the culture results on the curative effect were further compared by survival analysis. The correlations between sex, age, underlying diseases, sinus, disease course, joint involvement, surgical strategy, culture results and clinical outcomes were further analyzed by logistic regression.Results In total, there were 24 cases of CN PJI, with an incidence of 29.63%. The overall success rate of CN PJI was 86.4% (19/22),and overall success rate of CP PJI was 87.5% (42/48). There was no significant difference in the success rate between CN PJI and CP PJI. The incidence of antibiotic-related complications for CN PJI was significant higher than that for CP PJI, with 58.3% for CN PJI and 11.3% for CP PJI, respectively.Conclusion CN PJI was treated according to the strict standards for the diagnosis and treatment, and the success rate of treatment for CN PJI was similar to that for CP PJI. The incidence of antibiotic-related complications from CN PJI was higher than that from CP PJI.

One-stage revision is as effective as two-stage revision for chronic culture-negative periprosthetic joint infection after total hip and knee arthroplasty

2021 ◽  
pp. 1-7
Author(s):  
Janna van den Kieboom ◽  
Venkatsaiakhil Tirumala ◽  
Hayden Box ◽  
Ruben Oganesyan ◽  
Christian Klemt ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Randomized Study ◽  
Treatment Strategies ◽  
Revision Arthroplasty ◽  
Two Stage ◽  
One Stage ◽  
Hip And Knee Arthroplasty ◽  
Culture Negative

Aims Removal of infected components and culture-directed antibiotics are important for the successful treatment of chronic periprosthetic joint infection (PJI). However, as many as 27% of chronic PJI patients yield negative culture results. Although culture negativity has been thought of as a contraindication to one-stage revision, data supporting this assertion are limited. The aim of our study was to report on the clinical outcomes for one-stage and two-stage exchange arthroplasty performed in patients with chronic culture-negative PJI. Methods A total of 105 consecutive patients who underwent revision arthroplasty for chronic culture-negative PJI were retrospectively evaluated. One-stage revision arthroplasty was performed in 30 patients, while 75 patients underwent two-stage exchange, with a minimum of one year's follow-up. Reinfection, re-revision for septic and aseptic reasons, amputation, readmission, mortality, and length of stay were compared between the two treatment strategies. Results The patient demographic characteristics did not differ significantly between the groups. At a mean follow-up of 4.2 years, the treatment failure for reinfection for one-stage and two-stage revision was five (16.7%) and 15 patients (20.0%) (p = 0.691), and for septic re-revision was four (13.3%) and 11 patients (14.7%) (p = 0.863), respectively. No significant differences were observed between one-stage and two-stage revision for 30- 60- and 90-day readmissions (10.0% vs 8.0%; p = 0.714; 16.7% vs 9.3%; p = 0.325; and 26.7% vs 10.7%; p = 0.074), one-year mortality (3.3% vs 4.0%; p > 0.999), and amputation (3.3% vs 1.3%; p = 0.496). Conclusion In this non-randomized study, one-stage revision arthroplasty demonstrated similar outcomes including reinfection, re-revision, and readmission rates for the treatment of chronic culture-negative PJI after TKA and THA compared to two-stage revision. This suggests culture negativity may not be a contraindication to one-stage revision arthroplasty for chronic culture-negative PJI in selected patients.

scholarly journals Does serum interleukin-6 guide the diagnosis of persistent infection in two-stage hip revision for periprosthetic joint infection?

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Peng-Fei Qu ◽  
Chi Xu ◽  
Jun Fu ◽  
Rui Li ◽  
Wei Chai ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Interleukin 6 ◽  
Persistent Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Roc Curves ◽  
Two Stage ◽  
Predictive Values ◽  
Musculoskeletal Infection ◽  
Significant Difference

Abstract Purpose The diagnosis of persistent infection at reimplantation of two-stage revision arthroplasty for periprosthetic joint infection (PJI) remains challenging. Several studies have shown the benefit of serum interleukin-6 (IL-6) in diagnosing periprosthetic joint infection (PJI). Recent data indicated serum IL-6 could be promising in differentiating persistent infection. The purpose of this study was to validate the efficacy of serum IL-6 in diagnosing persistent infection at reimplantation. Methods A retrospective review of 86 PJI patients with a two-stage exchanged hip arthroplasty from 2013 to 2017 was conducted. Persistent infection was defined using the modified Musculoskeletal Infection Society (MSIS) criteria combined with follow-up results. Serum IL-6 at reimplantation were collected and compared among patients with or without persistent infection. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic performance and optimal cut-off value of serum IL-6 at reimplantation. Results Sixteen cases were diagnosed as persistent infection at reimplantation. There was no significant difference in serum IL-6 levels between cases with persistent infection and controls (7.89 pg/ml vs. 5.56 pg/ml; P = 0.179). The area under the ROC curve (AUC) for serum IL-6 in diagnosing persistent infection at reimplantation was 0.59 (95% confidential interval [CI] 0.40–0.77). With the calculated threshold set at 8.12 pg/ml, the corresponding sensitivity, specificity, positive predictive value, and negative predictive values were 38%, 88%, 38%, and 87%, respectively. Conclusion Serum IL-6 is inadequate in diagnosing persistent infection at reimplantation for two-stage revision arthroplasty. With the serum IL-6 threshold set at 8.12 pg/ml, the specificity to rule out persistent infection is high, but the sensitivity to predict persistent infection is not satisfactory.

scholarly journals 650. Relationship of a Multiplex Molecular Pneumonia Panel (PP) Results with Hospital Outcomes and Clinical Variables

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S299-S299
Author(s):  
Kenneth Rand ◽  
Stacy Beal ◽  
Elizabeth Tremblay ◽  
Herbert Houck ◽  
Kylie Weber ◽  
...  
Keyword(s):  
Positive Culture ◽  
Hospital Length Of Stay ◽  
Negative Group ◽  
Positive Group ◽  
Group 3 ◽  
Relationship Of ◽  
Positive Groups ◽  
Culture Positive ◽  
Culture Negative ◽  
Group 1

Abstract Background The Pneumonia Panel (PP) (BioFire Diagnostics, Salt Lake City, UT) detects 15 potentially pathogenic bacteria semiquantitatively (copy #/mL), 8 viruses and 7 resistance genes from the lower respiratory tract in ≈1 hour in the laboratory. Since identification and susceptibility take ≈ 2 days, this rapid result time is very attractive; however, the clinical significance of the PP copy #/mL as well as a predictable group of PP positive but culture negative patients is unknown. We retrospectively studied the relationship of 270 PP results to culture results, clinical data and outcomes. Methods Bronchoalveolar lavage fluid (N = 197) and endotracheal aspirates (N = 73) submitted to the UF Health Shands Hospital microbiology laboratory from June-September 2018 were frozen at −70°C, until tested on the PP. Patient data were extracted from the inpatient electronic medical record (Epic). Results Of 270 patients tested, 111/270 (41.1%) were PP bacteria negative/culture no growth or normal flora (Group 1), 59/270 (21.9%) were PP positive/culture negative (Group 2), and 100/270 (37.0%) were PP positive/culture positive (Group 3) for at least 1 concordant bacterial potential pathogen. Hospital length of stay (LOS), P = 0.0274, ANOVA; ICU LOS P = 0.0007 and BAL % Polys P < 0.0001 were significantly longer/higher in Group 3 than in Groups 1 and 2 (Table 1). Max daily temp on the day of culture in PP-positive groups 2 and 3 was significantly higher than the PP-negative group 1, P = 0.0260, ANOVA, (Table 1). Age, daily WBC, lowest paO2, max FiO2, % on antibiotics ( ≥80% for all groups), and % with viruses in the PP were not significantly different across groups. When all PP pathogens were grouped by copy # /mL, ICU LOS was significantly longer for 10(7) copies/mL (P = 0.0088), as was BAL % polys (P = 0.0006). Max daily temp was almost significantly higher for PP-positive groups 10(5), 10(6), and 10(7) combined compared with the PP-negative group (Table 2, P = 0.0608). Conclusion Hospital LOS was significantly longer and BAL %Polys higher in the bacterial pathogen culture-positive/PP-positive group vs. not positive groups. ICU LOS and BAL %Polys were significantly higher for the PP-positive groups vs. PP negative regardless of culture results. PP results (copy #/mL) independently correlated with outcome and clinical measures. Disclosures All authors: No reported disclosures.

Linkage between H. pylori Infection and TNF-α polymorphism in The Pregnant Women

2018 ◽  
Vol 9 (SPL1) ◽  
Author(s):  
Ghaidaa Raheem Lateef ◽  
Azhar Omaran Al-Thahab
Keyword(s):  
Pregnant Women ◽  
Serum Antibody ◽  
Rapid Test ◽  
Negative Group ◽  
Positive Group ◽  
Gynecology And Obstetrics ◽  
Tnf Α ◽  
Significant Difference ◽  
Pcr Products ◽  
H Pylori

A study was performed on 100 pregnant women in the outpatient department of gynecology and obstetrics of Maternity and Children Hospital in Al-Diwaniya City during the period between (March to September 2016). One hundred blood samples (50 for patients and 50 for control) were collected under the supervision of the treating gynecologist. The detection of Helicobacter. pylori was done by the use of the serum antibody Rapid test. The results showed that 50 (100%) were positive and 50 (100%) were negative for H. pylori in above method.All blood of patients and control samples were used for the extraction of genomic DNA,where the 107 bp PCR product size. Genotyping of the TNF-α-308 SNP (G/A)was performed by restriction fragment length polymorphism PCR (RFLP-PCR). PCR products were digested with restr NcoI iction enzyme. Individuals with the TNF-α-308(GG) homozygote produced digested DNA bands at 80,and 20 bp bp. A heterozygous genotype ofTNF-α-308 (GA)produced 107 bp,80 bp,and 20 bp bands. Individuals with the TNF-α-308 (AA) homozygote genotype had no amplicon digested and generated only one band of 107 bp. There was a significant difference in the frequency of the TNF-α-308(GG)genotype between H. pylori positive group and H. pylori negative group(72%,78% respectively). Also for GA genotype,there was a significant difference between H. pylori positive group and H. pylori negative group(24%,18% respectively). Concerning the frequency of the TNF-α-308 (AA)genotype between H. pylori positive group and H. pylori negative group,there was no significant difference between the two groups.

Sign in / Sign up

Export Citation Format

Share Document