Prevalence and Impact of Positive Intraoperative Cultures in Partial Hip or Knee Revision

Vargas-Reverón, Caribay; Soriano, Álex; Fernández-Valencia, Jenaro Á.; Martínez-Pastor, Juan C.; Morata, Laura; Muñoz-Mahamud, Ernesto

doi:10.1016/j.arth.2020.02.025

Cited by 16 publications

(14 citation statements)

References 13 publications

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“…The Musculoskeletal Infection Society (MSIS) published a definition in 2011 (6), which was infections. There is now a greater understanding of low-grade infections, which may have been missed in the past (11,12), and how inappropriate treatment may impact outcomes (13)(14)(15). With the purpose to overcome this limitation, EBJIS recently proposed a new set of criteria (16).…”

Section: Periprosthetic Joint Infection (Pji) Is Among the Most Frequ...mentioning

confidence: 99%

“…Perhaps the major concern with earlier PJI definitions is the potential for lower sensitivity to diagnose the full spectrum of infections. There is now a greater understanding of low-grade infections, which may have been missed in the past ( 11 , 12 ), and how inappropriate treatment may impact outcomes ( 13 - 15 ). With the purpose to overcome this limitation, EBJIS recently proposed a new set of criteria ( 16 ).…”

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confidence: 99%

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The European Bone and Joint Infection Society definition of periprosthetic joint infection is meaningful in clinical practice: a multicentric validation study with comparison with previous definitions

Sousa

Ribau

Alfaro

et al. 2023

ActaO

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Background and purpose: A new periprosthetic joint infection (PJI) definition has recently been proposed by the European Bone and Joint Infection Society (EBJIS). The goals of this paper are to evaluate its diagnostic accuracy and compare it with previous definitions and to assess its accuracy in preoperative diagnosis.Patients and methods: We retrospectively evaluated a multicenter cohort of consecutive revision total hip and knee arthroplasties. Cases with minimum required diagnostic workup were classified according to EBJIS, 2018 International Consensus Meeting (ICM 2018), Infectious Diseases Society of America (IDSA), and modified 2013 Musculoskeletal Infection Society (MSIS) definitions. 2 years’ minimum follow-up was required to assess clinical outcome.Results: Of the 472 cases included, PJI was diagnosed in 195 (41%) cases using EBJIS; 188 (40%) cases using IDSA; 172 (36%) using ICM 2018; and 145 (31%) cases using MSIS. EBJIS defined fewer cases as intermediate (5% vs. 9%; p = 0.01) compared with ICM 2018. Specificity was determined by comparing risk of subsequent PJI after revision surgery. Infected cases were associated with higher risk of subsequent PJI in every definition. Cases classified as likely/confirmed infections using EBJIS among those classified as not infected in other definitions showed a significantly higher risk of subsequent PJI compared with concordant non-infected cases using MSIS (RR = 3, 95% CI 1–6), but not using ICM 2018 (RR = 2, CI 1–6) or IDSA (RR = 2, CI 1–5). EBJIS showed the highest agreement between pre-operative and definitive classification (k = 0.9, CI 0.8–0.9) and was better at ruling out PJI with an infection unlikely result (sensitivity 89% [84–93], negative predictive value 90% [85–93]).Conclusion: The newly proposed EBJIS definition emerged as the most sensitive of all major definitions. Cases classified as PJI according to the EBJIS criteria and not by other definitions seem to have increased risk of subsequent PJI compared with concordant non-infected cases. EBJIS classification is accurate in ruling out infection preoperatively.

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Section: Periprosthetic Joint Infection (Pji) Is Among the Most Frequ...mentioning

confidence: 99%

mentioning

confidence: 99%

The European Bone and Joint Infection Society definition of periprosthetic joint infection is meaningful in clinical practice: a multicentric validation study with comparison with previous definitions

Sousa

Ribau

Alfaro

et al. 2023

ActaO

View full text Add to dashboard Cite

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“…5,14 Especially puzzling are infections that occur late in the process of surgical recovery, weeks to months following the operation. 15 These are most often associated with the presence of a foreign body such as a vascular graft or a joint prosthesis. Majority of these infections are due to bacteria also found on skin or found colonizing surfaces (i.e., Staphy-lococcus aureus).…”

Section: Contamination Cannot Be the Sole Explanation Of Surgical Sit...mentioning

confidence: 99%

The Role of the Gut Microbiome on the Development of Surgical Site Infections

Krezalek

Alverdy

2023

Clin Colon Rectal Surg

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Despite advances in antisepsis techniques, surgical site infection remains the most common and most costly reason for hospital readmission after surgery. Wound infections are conventionally thought to be directly caused by wound contamination. However, despite strict adherence to surgical site infection prevention techniques and bundles, these infections continue to occur at high rates. The contaminant theory of surgical site infection fails to predict and explain most postoperative infections and still remains unproven. In this article we provide evidence that the process of surgical site infection development is far more complex than what can be explained by simple bacterial contamination and hosts' ability to clear the contaminating pathogen. We show a link between the intestinal microbiome and distant surgical site infections, even in the absence of intestinal barrier breach. We discuss the Trojan-horse mechanisms by which surgical wounds may become seeded by pathogens from within one's own body and the contingencies that need to be met for an infection to develop.

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“…Thus, it is reasonable to suspect that much of these so-called "early aseptic loosenings" are, in fact, a missed diagnosis of lowgrade PJI. Recently, the physiopathology of aseptic loosening has been evaluated [11], and some studies using implant sonication have documented the presence of microorganisms in up to 12% to 33% of patients with a preoperative diagnosis of aseptic loosening [2,5,10,16,17]. Thus, it seems reasonable to evaluate the potential association between positive culture results during primary arthroplasty and the risk of revision surgery for different causes after long-term followup.…”

Section: Introductionmentioning

confidence: 99%

Do Cultures Obtained During Primary THA Predict the Likelihood of Revision?

Vargas-Reverón

Font-Vizcarra

Morata

et al. 2022

Clin Orthop Relat Res

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BackgroundThere can be unexpectedly positive culture results during elective hip arthroplasty, but the degree to which these are associated with an increased risk of subsequent premature revision is not known.Question/purposeAre unexpectedly positive culture results obtained during elective THA associated with an increased likelihood of revision within 5 years of the procedure?MethodsBetween March 2007 and March 2011, the hip unit at our institution performed elective primary THA in 829 patients. We systematically collected three samples in 52% (428 of 829) of the interventions. Of those, 26 patients were excluded because of sampling errors; 94% (402 of 428) had samples that were collected systematically and were eligible for the study. We only considered one hip randomly in bilateral procedures (4% [15 of 428]); patients presenting with acute (< 3 months) periprosthetic joint infection undergoing open debridement (4% [16 of 402]) and patients who died before 5 years of follow-up (2% [seven of 402]) were excluded from the study, leaving 91% (364 of 402) eligible for analysis in this retrospective study of a previous prospective trial. No patient included in the final analysis was lost to follow-up within 5 years from the index surgery. The patient group consisted of 52% (188 of 364) women, with a mean ± SD age of 64.8 ± 13.9 years.ResultsPositives culture results were associated with a higher risk of revision within 5 years of the index surgery. The proportion of revision surgery was higher in the group with positive culture results than in those with negative results (10% [eight of 77] versus 2% [seven of 290]; p = 0.01). The difference was mainly attributable to a higher proportion of aseptic loosening in those with positive culture results than in those with negative results (8% [six of 74] versus 1% [four of 290]; p = 0.01). After a multivariable analysis, the only independent variable associated with 5-year revision surgery was the presence of positive results during THA (odds ratio 4.9 [95% confidence interval 1.72 to 13.99]).ConclusionOur findings suggest that bacterial contamination during THA is associated with an increased likelihood of early revision. This higher risk of revision is mainly because of presumed aseptic loosening; thus, efforts should focus on the need to rule out infection. These results not only open new questions that should be answered in new prospective and well-designed studies, but also may help to better select patients to obtain a more favorable outcome after THA.Level of EvidenceLevel III, therapeutic study.

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Prevalence and Impact of Positive Intraoperative Cultures in Partial Hip or Knee Revision

Cited by 16 publications

References 13 publications

The European Bone and Joint Infection Society definition of periprosthetic joint infection is meaningful in clinical practice: a multicentric validation study with comparison with previous definitions

The European Bone and Joint Infection Society definition of periprosthetic joint infection is meaningful in clinical practice: a multicentric validation study with comparison with previous definitions

The Role of the Gut Microbiome on the Development of Surgical Site Infections

Do Cultures Obtained During Primary THA Predict the Likelihood of Revision?

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