Preoperative Aspiration Culture for Preoperative Diagnosis of Infection in Total Hip or Knee Arthroplasty

Qu, Xinhua; Zhai, Zanjing; Wu, Chuanlong; Jin, Fangchun; Li, Haowei; Wang, Lei; Liu, Guangwang; Liu, Xuqiang; Wang, Wengang; Li, Huiwu; Zhang, Xiaoyu; Zhu, Zhenan; Dai, Kerong

doi:10.1128/jcm.01467-13

Cited by 82 publications

(43 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This may be due to a number of factors, including a difference in the load of microorganisms, administration of antimicrobials before aspiration, and the infecting pathogen. Finally, a recent meta-analysis of 34 studies including 3,332 patients found a pooled sensitivity of 72% and a specificity of 95% for synovial fluid culture (293). Subgroup analysis was unrevealing but did not examine the method of culture.…”

Section: Synovial Fluid Analysismentioning

confidence: 99%

Prosthetic Joint Infection

2014

View full text Add to dashboard Cite

SUMMARY Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided.

show abstract

Section: Synovial Fluid Analysismentioning

confidence: 99%

Prosthetic Joint Infection

2014

View full text Add to dashboard Cite

show abstract

“…We did consider Ն3 intraoperative biopsy samples sufficient when tissue samples of the same surgical site were compared before and after the administration of antimicrobial prophylaxis, since a false-negative culture due to sampling error is less likely in this case. The risk of bias was considered high for the reference test when patients did not serve as their own control and culture yield was compared only with that of a control group (31). Since variations in bacterial inoculum are not expected in chronic PJI, the risk of bias regarding the interval between the collection of preoperative synovial fluid and intraoperative samples (flow and timing) was neglected.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: a Systematic Review

2017

View full text Add to dashboard Cite

Obtaining reliable cultures during revision arthroplasty is important to adequately diagnose and treat a prosthetic joint infection (PJI). The influence of antimicrobial prophylaxis on culture results remains unclear. Since withholding prophylaxis increases the risk for surgical site infections, clarification on this topic is critical. A systematic review was performed with the following research question: in patients who undergo revision surgery of a prosthetic joint, does preoperative antimicrobial prophylaxis affect the culture yield of intraoperative samples in comparison with nonpreoperative antimicrobial prophylaxis? Seven articles were included in the final analysis. In most studies, standard diagnostic culture techniques were used. In patients with a PJI, pooled analysis showed a culture yield of 88% (145/165) in the prophylaxis group versus 95% (344/362) in the nonprophylaxis group ( = 0.004). Subanalysis of patients with chronic PJIs showed positive cultures in 88% (78/89) versus 91% (52/57), respectively ( = 0.59). In patients with a suspected chronic infection, a maximum difference of 4% in culture yield between the prophylaxis and nonprophylaxis groups was observed. With the use of standard culture techniques, antimicrobial prophylaxis seems to affect cultures in a minority of patients. Along with the known risk of surgical site infections due to inadequate timing of antimicrobial prophylaxis, we discourage the postponement of prophylaxis until tissue samples are obtained in revision surgery. Future studies are necessary to conclude whether the small percentage of false-negative cultures after prophylaxis can be further reduced with the use of more-sensitive culture techniques, like sonication.

show abstract

“…The protocol used in the present meta-analysis was conducted as described in our previous studies (6,7,29) and based on recommendations in the methodological guidelines for conducting systematic reviews studying diagnostic accuracy (30) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (31).…”

Section: Methodsmentioning

confidence: 99%

“…GS is also commonly used in the diagnosis of PJI, particularly in developing countries, as a result of its low cost, rapid turnaround time and ease of use; however, its value remains controversial due to conflicting results on the effectiveness of GS in the diagnosis of PJI (5,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). The present meta-analysis was therefore performed as one of a series of meta-analyses (6,7,29) in order to evaluate the detection validity of GS for the diagnosis of PJI and to provide evidence-based advice to clinicians.…”

Section: Introductionmentioning

confidence: 99%

“…Although various techniques can be used for the diagnosis of PJI, including preoperative laboratory tests, radiological examination, nuclear medicine detection, intraoperative culture and histopathology (5)(6)(7)(8), no gold-standard test for the diagnosis of PJI has been established, and the limited sensitivity and specificity of the tests that are available make the differentiation between PJI and other causes of prosthetic failure, such as metal allergy or aseptic loosening, challenging (2,9). PJI continues to cause difficulties for orthopedic surgeons, particularly when the clinical signs and regular serum inflammatory markers are not fully indicative of infection (10).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Limitations of Gram staining for the diagnosis of infections following total hip or knee arthroplasty

Ouyang

Zhai

Qin

et al. 2015

Experimental and Therapeutic Medicine

Self Cite

View full text Add to dashboard Cite

Abstract. The diagnosis of prosthetic joint infection (PJI)following total joint arthroplasty is difficult for clinicians to make decisions due to the similar symptoms presented by aseptic loosening and infection. Gram staining (GS) is a widely used test but its value remains controversial due to conflicting results in the diagnosis of PJI. The aim of the present study was therefore to evaluate the value of GS in the diagnosis of PJI. Searches using MEDLINE, EMBASE and OVID databases were conducted for data published between January 1990 and December 2013. Meta-analysis was used to pool the sensitivity, specificity, diagnostic odd ratios (DORs), area under the receiveroperating characteristic curve (AUC), positive-likelihood ratios (PLRs), negative-likelihood ratios (NLRs) and post-test probability. The heterogeneity and publication bias were assessed, and subgroup and meta-regression analyses were conducted. A total of 18 studies, including a total of 4,647 patients, were selected for analysis. The pooled sensitivity and specificity values for the diagnosis of PJI were 0.19 and 1.00, respectively. The AUC, PLR and NLR were 0.89, 41.6 and 0.82, respectively. Subgroup analyses indicated that the sensitivity/specificity for total hip arthroplasty was 0.14/0.99, whereas that for total knee arthroplasty was 0.14/1.00. Synovial fluid best reflected accurate GS-based diagnoses, with the highest DOR of 242, whereas tissue had the highest AUC of 0.96 (95% CI, 0.94-0.97). GS had a poor clinically acceptable diagnostic value for detecting PJI. These data do not support the routine use of GS, without additional proof of infection, for diagnosing PJI; instead, GS could be used as an adjuvant tool to support the results of other investigations.

show abstract

Preoperative Aspiration Culture for Preoperative Diagnosis of Infection in Total Hip or Knee Arthroplasty

Cited by 82 publications

References 51 publications

Prosthetic Joint Infection

Prosthetic Joint Infection

The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: a Systematic Review

Limitations of Gram staining for the diagnosis of infections following total hip or knee arthroplasty

Contact Info

Product

Resources

About