A Review of the Literature on Culture-Negative Periprosthetic Joint Infection: Epidemiology, Diagnosis and Treatment

Abstract

PurposeThe prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification of causative microorganisms is crucial for treatment of PJI, culture-negative (CN) PJI is a significant clinical issue. The purpose of the present study is to describe epidemiology, diagnosis and treatment of CN PJI based on review of the literature to help prevent delayed diagnosis and improve clinical outcomes of CN PJI.MethodsMEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for articles on CN PJI. Only clinical studies written in English were included. Basic science studies, letters to the editor, case reports and review articles on PJI were excluded.ResultsSeven studies were included in this study. The prevalence of CN PJI ranged from 0% to 42.1%. The major risk factors for CN PJI were prior antibiotic use and presence of postoperative wound drainage. Vancomycin and cephalosporins were the most commonly used antibiotics for CN PJI. Two-stage revision arthroplasty followed by 6 weeks of antibiotic therapy produced the most successful treatment outcomes.ConclusionsIn most clinical studies on CN PJI, a definite diagnostic method for identifying causative microorganisms or optimal treatment strategy for CN PJI were not clearly described. Therefore, further studies are needed to establish standard diagnostic methods for identifying infecting organisms and treatment strategies for CN PJI.

Can metagenomic next-generation sequencing identify the pathogens responsible for culture-negative prosthetic joint infection?

“…Therefore, we included cases from January 2016 to ensure the conformity of the two groups. Twenty-seven cases of CN-PJI cases (27.84%) were recorded among the 97 consecutive PJI cases during the study period, and this rate is similar to that reported in the literature [5,20]. This result reflects the actual situation at the PJI referral center to some extent.…”

“…Due to pathogen encapsulation within biofilms [1], low microbial concentrations [2], the prior use of antibiotics [3], and the difficulty associated with the culturing of some pathogens [4], culture-negative prosthetic joint infection (CN-PJI) accounts for approximately 7-12% of all PJI cases [5]. The current guidelines and the consensus opinion recommend the use of empirical therapy with vancomycin and broad-spectrum beta-lactams (piperacillin/tazobactam or third-generation cephalosporins) for the treatment of CN-PJI [6][7][8].…”

The Toxin Antitoxin MazEF DrivesStaphylococcus aureusChronic Infection

“…Total knee arthroplasty is a common surgical procedure, and the most common reason for failure is infection, termed periprosthetic joint infection (3, 4). S. aureus periprosthetic joint infection can be culture negative for prolonged periods (5, 6), has high failure rates above 50% once treatment is initiated (5), and a 5-year mortality of 20% (7–9), higher than many common cancers (10). Similar to other surgical implant associated infections, the challenge in treating this disease involves the ability of S. aureus to develop a chronic biofilm associated infection tolerant to antibiotics (11, 12).…”

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

“…In the clinic, CN PJIs are not uncommon. It has been reported that the incidence of CN PJI is between 0% and 42.1% 5 .…”

“…Other surgical strategies include DAIR with replacement of the polyethylene insert, one-stage revision, permanent joint fusion, etc. 5 . A systemic combination of vancomycin and third-generation cephalosporins or carbapenems is the most commonly used regimen for CN PJI 5 .…”