Comparing Standard Versus Extended Culture Duration in Acute Hip and Knee Periprosthetic Joint Infection

Abstract

Introduction: Periprosthetic joint infection (PJI) is a devastating complication of hip and knee arthroplasties. Surgical cultures are essential for the diagnosis and treatment of PJI. Yet, the ideal culture duration remains unclear. This study compares culture yield, organism profile, and treatment success between standard (5 days) and extended (14 days) cultures in acute hip and knee PJI. Methods: A retrospective review of medical records was completed between 2006 and 2015. All patients with an acute PJI meeting the modified International Consensus Meeting on PJI criteria of a primary hip or knee arthroplasty were included. All patients underwent irrigation and débridement with exchange of modular bearing surfaces for an acute postoperative or acute hematogenous infection. A standard growth cohort (before February 2012) was compared with an extended growth cohort (after February 2012) to determine if differences existed in culture yield and treatment success using the Delphi consensus criteria. Results: One hundred eighty-nine patients were analyzed, including 102 (54.0%) standard duration and 87 (46.0%) extended duration cohorts. Patient cohorts were closely matched, except more hip PJIs than knee PJIs were included in the standard cohort (69.6% versus 49.4%; P = 0.005). No differences between standard and extended cohorts were observed with regard to overall culture yield, monomicrobial growth, or polymicrobial growth. Propionibacterium acnes was identified more often in the extended cohort (5 versus 0 patients; P = 0.019). However, four of these patients had only one positive P acnes culture and grew additional organisms. Finally, no difference in treatment success between the standard and extended cohorts at the final follow-up was found (53% versus 52%; P = 0.282). Conclusion: Extended culture duration in acute hip and knee PJIs did not change the rate of culture-negative PJI, identify more patients with polymicrobial PJI, or improve the success of surgical treatment. The only difference was a higher incidence of P acnes growth, but contaminants or indolent chronic PJI cannot be excluded. Although extended culture growth may be indicated in acute shoulder arthroplasty PJI, its utility in hip or knee arthroplasty may be limited. Higher-level studies will be needed to address this in the future.

Current Clinical Methods for Detection of Peri-Prosthetic Joint Infection

“…Interestingly, true positive infections with C. acnes in this setting grew positive cultures sooner (mean of five days) rather than later (greater than 11 days). Of patients with C. acnes growth, 80% had only one positive culture and cultures were polymicrobial, possibly indicating contamination [14]. This reinforces previous findings [15] that extended culturing durations up to 14 days are more likely to show a false positive from non-virulent pathogens or possible contamination.…”

“…It is seen less frequently in total hip arthroplasty and total knee arthroplasty (THA and TKA). In THA and TKA, culture duration of 14 days shows no benefit compared with shorter culturing periods, except more frequent growth of contaminants [14]. Interestingly, true positive infections with C. acnes in this setting grew positive cultures sooner (mean of five days) rather than later (greater than 11 days).…”

“…This leads to delays in diagnosis, treatment, and increased complications. In addition, accurate bacterial identification can be obscured because of contamination by commensal bacteria and contamination between plates during storage and incubation [14,15].…”

Occurrence of Rare Pathogens at the Site of Periprosthetic Hip and Knee Joint Infections: A Retrospective, Single-Center Study

“…The use of molecular biological techniques, such as polymerase chain reaction (PCR), also count as an enhancement to diagnostic measures despite their susceptibility to contamination and inhibition [26][27][28]. Prolonged cultivation periods in the range of ≥ 14 days compared with standard cultures over 7 days demonstrated an increase in the detection rate by more than 25% [29], although more recent studies question the necessity of extended culture duration in acute periprosthetic hip and knee joint infections [30]. Last but not least, more tissue samples are nowadays taken during surgery and sent for further microbiological examination, thus increasing the possibility of a positive microbiological result.…”

Simultaneous Propionibacterium avidum and Propionibacterium acnes Chronic Periprosthetic Hip Joint Infection: A Case Report

“…As described in the literature, all the biological samples from the fine-needle evacuation of the femoral collection and the biopsies of the first revision were negative for P. acnes . Only the sonicated material, cultivated with an extended protocol (14 days) [ 8 ], was positive for this second microbiologic agent [ 9 ]. The low virulence of this bacterium makes it difficult to detect, and only sonication of the explanted material often leads to the diagnosis in previously misinterpreted aseptic implant loosening.…”