Comparison of infection control rates and clinical outcomes in culture-positive and culture-negative infected total-knee arthroplasty

Kim, Young Hoo; Kulkarni, Sourabh S.; Park, Jang Won; Kim, Jun Shik; Oh, Hyun Keun; Rastogi, Devarshi

doi:10.1016/j.jor.2015.01.020

Cited by 39 publications

(41 citation statements)

References 41 publications

(20 reference statements)

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“…The overall treatment success rates of CN PJI and CP PJI were 86.4% and 87.5%, respectively. There was no signi cant difference between the two groups (P =1.000), which was consistent with the conclusions reported in most previous studies [13][14][15][16][17] . It has been reported that DAIR and two-stage revision are the two main surgical strategies for CN PJI, and the rate of infection eradication can reach 73-94% 17 .…”

Section: Discussionsupporting

confidence: 92%

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

Cai

Mei

et al. 2020

Preprint

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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.

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Section: Discussionsupporting

confidence: 92%

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

Cai

Mei

et al. 2020

Preprint

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“…Parenteral antibiotics is mainly used for 6 weeks for CN PJI; however, the appropriate duration of oral antibiotic therapy for CN PJI followed by surgical treatment has yet to be established. CN PJIs are often the cause of anxiety for both the patient and the surgeon under circumstances when diagnosis is difficult due to failure to identify the infecting microorganism 5 , 11 , 12) . In addition, a long-term use of broad-spectrum antibiotics or multiple antibiotics against the most common infecting organisms can have a risk of toxicity and may not provide coverage against fungi or rare organisms 31) .…”

Section: Discussionmentioning

confidence: 99%

“…Brandt et al 36) reported that the procedure resulted in poor outcomes in PJI patients: infection control was achieved in less than 40%. Kim et al 11) also reported unsatisfactory outcomes: the treatment success rate was 62% for early deep infection and 25% for acute hematogenous infection. Because of such reports showing unsatisfactory outcomes of debridement and retention of implant, prosthesis exchange is currently recommended.…”

Section: Discussionmentioning

confidence: 99%

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

Yoon

Cho

Lee

et al. 2017

Knee Surg Relat Res

116

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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.

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“…Tissue samples removed at the first stage are sent for culture, though this method has a low sensitivity. The prevalence of culture-negative PJI in the literature ranges from 7 [4] to more than 40% [5,6].…”

Section: Introductionmentioning

confidence: 99%

Propidium monoazide–polymerase chain reaction for detection of residual periprosthetic joint infection in two-stage revision

et al. 2019

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False negative culture results in periprosthetic joint infection (PJI) are not uncommon particularly when patients have received long term antibiotics. Polymerase chain reaction (PCR) has a lower specificity partly due to detection of residual DNA from dead bacteria. Propidium monoazide (PMA) prevents DNA from dead bacteria from being amplified during the PCR. This study aimed to determine the role of PMA in PCR for diagnosis of PJI. Clinical samples were tested by PCR with and without prior treatment with PMA and compared to conventional microbiological culture. The PCR assay included genus-specific primers for staphylococci and enterococci and species-specific primers for Cutibacterium acnes. The validated conditions of PMA treatment used in this study were 20 μM concentration and 5 and 10 min of dark incubation and photo-activation respectively. 202 periprosthetic tissues and explanted prostheses from 60 episodes in 58 patients undergoing revision arthroplasties for either PJI or non-infective causes were tested, by culture, PCR, and PMA-PCR. 14 of the 60 episodes satisfied the Musculoskeletal Infection Society (MSIS) criteria for PJI and 46 did not. Sensitivity of culture, PCR, and PMA-PCR were 50%, 71%, and 79% respectively. Specificities were 98%, 72%, and 89% respectively. All figures were calculated for episodes rather than samples. PMA-PCR enhanced both the specificity and the sensitivity of PCR. It has the potential to detect residual bacterial viability prior to reimplantation in the two-stage revision for PJI.

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Comparison of infection control rates and clinical outcomes in culture-positive and culture-negative infected total-knee arthroplasty

Cited by 39 publications

References 41 publications

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

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

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

Propidium monoazide–polymerase chain reaction for detection of residual periprosthetic joint infection in two-stage revision

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