Comparable clinical outcomes of culture-negative and culture-positive periprosthetic joint infections: a systematic review and meta-analysis

Abstract

Purpose The aim of this study was to compare the clinical outcomes of culture-negative periprosthetic joint infection (CN PJI) with those of culture-positive periprosthetic joint infection (CP PJI). Methods Data were obtained from Embase, Web of Science and EBSCO for all available studies comparing the clinical outcomes of CN PJI with those of CP PJI. The quality of the studies was scored using the Newcastle–Ottawa scale (NOS). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess clinical outcomes. Subgroup analyses were performed to explain heterogeneity among the included studies. Publication bias was estimated using Begg’s funnel plot. Sensitivity analysis was performed to test the stability of pooled results. Results Thirty studies with 1630 (38.7%) CN PJI and 2577 (61.3%) CP PJI were included in this meta-analysis. The pooled results of the included studies showed that overall failure rate in CN PJI group (19.0%, 309/1630) was significantly lower than that in CP PJI group (23.4%, 604/2577) (OR 0.63, 95% CI 0.47–0.84, P = 0.002). We performed the subgroup analysis based on the surgical strategies, the pooled results of nine studies for patients undergoing debridement, antibiotics and implant retention (DAIR) revealed that failure rate in CN PJI group (22.2%, 53/239) was significantly lower than that in CP PJI group (29.3%, 227/775) (OR 0.62, 95% CI 0.43–0.90, P = 0.01), the pooled results of four studies for patients undergoing one-stage revision revealed that failure rate between CN PJI group (11.5%, 11/96) and CP PJI group (7.6%, 27/355) had no significant difference (OR 1.57, 95% CI 0.75–3.26, P = 0.23), and the pooled results of 19 studies for patients undergoing two-stage revision revealed that failure rate in CN PJI group (16.1%, 171/1062) was significantly lower than that in CP PJI group (20.4%, 206/1010) (OR 0.52, 95% CI 0.34–0.79, P = 0.002). Conclusions CN PJI group had similar or better survival rate when compared with CP PJI group for patients who underwent DAIR, one-stage or two-stage revision. Negative culture was not a worse prognostic factor for PJI.

The role of culture-negative infection among infectious complications after total knee arthroplasty

“…В 2018 г. опубликованы данные систематического мета-анализа исходов лечения КНИ, который включал обзор 8 англоязычных статей [30]. По объединенным данным, частота встречаемости инфекции с отрицательным микробиологическим посевом составила 11 % (n = 504) с частотой успеха 85-95 %, не было различий в частоте успеха с КПИ.…”

“…По объединенным данным, частота встречаемости инфекции с отрицательным микробиологическим посевом составила 11 % (n = 504) с частотой успеха 85-95 %, не было различий в частоте успеха с КПИ. Результаты недавнего мета-анализа, в который было включено 30 исследований, демонстрируют аналогичную или лучшую эффективность лечения КНИ в сравнении группой культуропозитивной ППИ -соответственно 81 и 76,4 % [30]. Одной их вероятных причин успеха лечения КНИ может быть банальное отсутствие инфекции в протезированном суставе, другой -наличие низковирулентных микроорганизмов, которые легче лечить, чем высоковирулентные, такие как метициллин-резистентный золотистый стафилококк [6].…”

“…Только Malekzadeh D. et al (2010) сообщают о сопоставимых результатах лечения 135 случаев КНИ -доля пациентов с купированной инфекцией через 5 лет после санации вне зависимости от сохранения или удаления эндопротеза составила 78 %[15]. Вместе с тем, результаты недавнего мета-анализа (2023) также показали, что выполнение операций с заменой инфицированного эндопротеза -как одно-, так и двухэтапных -было более эффективно для лечения КНИ в сравнении с санацией с сохранением эндопротеза -частота рецидивов составила, соответственно, 11,5, 16,1 и 22,2 % случаев[30]. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.…”

The Impact of Culture Negativity on the Outcomes of Revision Total Knee Arthroplasty for Chronic PJI

“…Research studies regarding outcomes following CN PJI have demonstrated differing results. Some scholars state that CN PJI yields worse outcomes as compared to those of culture positive (CP) PJI patients, arguing that the lack of identification of an infecting organism obscures treatment options and complicates both diagnosis and management of the infection (F. Li et al, 2023;Mortazavi et al, 2011). Others, however, have demonstrated that outcomes are more comparable or are even favorable for patients with CN PJI, attributing the negative culture to be indicative of a less severe infection (F. Li et al, 2023;H.…”

What Is the Most Reliable Concordance Rate of Preoperative Synovial Fluid Aspiration and Intraoperative Biopsy to Detect Periprosthetic Joint Infection in Knee, Hip and Shoulder Arthroplasty?

“…Preoperative microbiological diagnosis is the main condition of treatment in patients with PJI who are planned to undergo one-stage septic exchange [10], whereas two-stage revision is recommended for patients with culture-negative PJI [11].…”