Cultures in periprosthetic joint infections, the imperfect gold standard?

Abstract

Culture-negative periprosthetic joint infections (PJI) are commonly described in the literature. By implementing a routine diagnostic workup and by optimizing tissue sampling and processing, the culture-negative rate can easily be reduced. When faced with a culture-negative PJI, several serological and molecular techniques are available that may aid in finding the causative microorganism. Clinical clues may guide the treating physician towards more atypical and rare microorganisms. A multidisciplinary team consisting of orthopaedic surgeons, microbiologists and infectious disease specialist are warranted in tailoring diagnostic testing and deciding on the surgical and antibiotic treatment approach.

Modern Microbiological Methods to Detect Biofilm Formation in Orthopedy and Suggestions for Antibiotic Therapy, with Particular Emphasis on Prosthetic Joint Infection (PJI)

“…The usual cause of false-negative results is antibiotic treatment prior to sample obtaining. Most patients do not require antibiotic therapy before revision surgery, with the exceptions being critically ill cases and patients with septic symptoms [ 48 ]. According to the American Academy of Orthopedic Surgeons, if the patient received antibiotics, they should be discontinued for at least 2 weeks before the surgery to obtain reliable intra-operative samples [ 49 ].…”

Improved cure rate of periprosthetic joint infection through targeted antibiotic therapy based on integrated pathogen diagnosis strategy

“…Microbiological culture plays a vital role in PJI diagnosis, involving preoperative aspiration of joint fluid for culture and intraoperative collection of multiple periprosthetic tissue specimens ( Osmon et al., 2013 ; Stylianakis et al., 2018 ). However, conventional culture lacks perfect sensitivity and specificity, frequently resulting in missed diagnoses and treatment delays ( Trampuz et al., 2007 ; Wouthuyzen-Bakker, 2023 ). Numerous factors collectively impact the accuracy of PJI diagnosis, such as inadequate preoperative joint fluid sampling, challenges in culturing intraoperative tissues, reduced planktonic bacteria in joint fluid due to biofilm formation ( Jeyanathan et al., 2021 ), prior antibiotic exposure before culture ( Malekzadeh et al., 2010 ), insufficient culture duration ( Butler-Wu et al., 2011 ), improper specimen handling leading to microbial load loss ( Van Cauter et al., 2018 ), and fastidious growth requirements of some pathogens ( Brzezinski et al., 2021 ).…”