Prevalence and Outcomes of Unexpected Positive Intraoperative Cultures in Presumed Aseptic Revision Hip Arthroplasty

Abstract

Background:The prevalence and outcomes of unexpected positive cultures (UPCs) of specimens taken during presumed aseptic revision total hip arthroplasty (THA) are unclear. The purpose of this study was to determine the prevalence of UPC and infection-free implant survival in this patient population. Secondary aims included identifying factors associated with subsequent infection-related failure in patients with UPC.Methods:We reviewed all THA revisions (n = 2,288) performed at our institution from 2006 to 2019. Presumed aseptic revision THAs with intraoperative culture(s) were eligible (n = 1,196), and those with UPC were included in a Kaplan-Meier analysis to determine the infection-free implant survival and in Cox regression analysis to identify factors associated with infection-related failure.Results:UPC(s) were documented for 9.2% (110) of 1,196 aseptic THA revisions. The 2- and 5-year infection-free implant survival in the entire UPC cohort was 93.1% (95% confidence interval [CI] = 90.5% to 95.7%) and 86.8% (95% CI = 82.9% to 90.7%), respectively. The 2- and 5-year infection-free survival with failure due to infection with the same microorganism as identified in the UPC as the end point was 95.8% (95% CI = 93.7% to 97.9%) and 94.3% (95% CI = 91.7% to 96.9%), respectively. Subsequent infection-related failures caused by the same microorganism as identified in the UPC were more likely to occur after revisions with ≥2 UPCs than after those with 1 UPC (p = 0.024). Revision due to adverse metal reaction was a risk factor for subsequent infection-related failure (hazard ratio [HR] = 14.49, 95% CI = 2.69 to 78.04). Patients with a single UPC who were not treated with antibiotics had no subsequent periprosthetic joint infections (PJIs) caused by the same microorganism as identified in the UPC.Conclusions:The prevalence of UPC was 9.2%, and the infection-free implant survival in patients with UPC is encouraging. Implant survival free of PJI caused by the same microorganism as identified in the UPC was excellent. Aseptic revision for adverse metal reaction was a risk factor for subsequent PJI in patients with UPC. No patient with a single UPC who was not treated with antibiotics developed PJI caused by the UPC-identified microorganism, suggesting that in the absence of other signs of infection a single UPC does not warrant antibiotic treatment.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Bone infection site targeting nanoparticle-antibiotics delivery vehicle to enhance treatment efficacy of orthopedic implant related infection

“…Antibiotic therapy continues to play a vital role in the clinical treatment of orthopedic implant-related infections, usually involving systemic or local antibiotic therapy at high doses over a prolonged period [ 4 , 5 ]. However, the current antibiotic therapy is still far from satisfactory, with treatment failure rates of approximately 20% [ 6 ]. There are various reasons for such high rates.…”

Amplicon-Based Next-Generation Sequencing as a Diagnostic Tool for the Detection of Phylotypes of Cutibacterium acnes in Orthopedic Implant-Associated Infections

“…Moreover, C. acnes have been detected intracellularly within stromal cells and macrophages of intraarticular tissue samples of patients undergoing primary shoulder surgery, suggesting the possibility of it being an intraarticular commensal ( Hudek et al, 2021 ). Thus, when C. acnes is isolated in patients without obvious clinical or laboratory features of OIAI, it is difficult to determine its clinical significance, and if it should be treated ( Dorrestijn and Pruijn, 2021 ; Falstie-Jensen et al, 2021 ; Neufeld et al, 2021 ; Pruijn et al, 2021 ; Spek et al, 2021 ). There is therefore a risk of over- or undertreatment.…”

Unexpected positive intraoperative cultures (UPIC) at index osseointegration do not lead to increased postoperative infectious events

“…There appears to be low consensus regarding the optimal management of UPIC in revision total joint replacement (Purudappa et al, 2020). Although some literature suggests a single positive culture at revision joint replacement may not require treatment (Neufeld et al, 2021), we prefer to treat even a single positive culture at osseointegration.…”