The concordance between preoperative aspiration and intraoperative synovial fluid culture results: intraoperative synovial fluid re-cultures are necessary whether the preoperative aspiration culture is positive or not

Abstract

Aims Preoperative aspiration culture and intraoperative cultures play pivotal roles in periprosthetic joint infection (PJI) diagnosis and pathogen identification. But the discordance between preoperative aspiration culture and intraoperative synovial fluid culture remains unknown. We aim to determine (1) the discordance between preoperative and intraoperative synovial fluid (SF) culture and. (2) compared to intraoperative synovial fluid cultures, the sensitivity of preoperative aspiration fluid culture. Then the following question is tried to be answered: Are intraoperative synovial fluid re-cultures necessary if the preoperative aspiration culture is positive? Materials and methods Between 2015 and 2019, 187 PJI patients managed with surgeries were included in this study. Compared to intraoperative synovial fluid culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative aspiration culture were calculated. Then, the discordance between preoperative aspiration culture and intraoperative SF culture was analyzed. Results The sensitivity of preoperative aspiration culture was 81.29% compared to intraoperative synovial fluid cultures. Concordance was identified in 147 PJI (78.61%) patients and culture discordance occurred in 40 patients (21.39%). In these discordant PJI patients, 24 patients (60%) were polymicrobial and no intraoperative synovial fluid culture growth was found in 16 PJI cases (40%). Preoperative monomicrobial staphylococcus results had a sensitivity of and a specificity of 80.43% and 83.16%, respectively. Preoperative polymicrobial results had the lowest sensitivity. Conclusions The intraoperative synovial fluid re-cultures are necessary if the preoperative aspiration culture is positive and the discordance between preoperative aspiration culture and intraoperative synovial fluid culture should be noted especially when Streptococcus spp. and more than one pathogen was revealed by preoperative aspiration culture. Level of evidence: Level III.

What Is the Most Reliable Concordance Rate of Preoperative Synovial Fluid Aspiration and Intraoperative Biopsy to Detect Periprosthetic Joint Infection in Knee, Hip and Shoulder Arthroplasty?

“…The number of studies investigating the said concordance has risen recently due to the polymicrobial infections encountered, contamination issues and other such problems [5,7]. These studies present the overall concordance values rather than classifying patients with PJI according to the joints involved [5,24]. In this study, each group was separately evaluated, and the highest concordance rate was observed in the knee group (60%), followed by the shoulder (56%) and hip (54%) groups.…”

Antibiotic Prophylaxis in One-Stage Revision of Septic Total Knee Arthroplasty: A Scoping Review

“…Pathogen identification is critical in the management of PJI as such information can guide not only the administration of perioperative antibiotics, but also treatment protocols, and can also guide the clinician in deciding a prognosis [ 89 ]. Although preoperative aspiration cultures are more convenient and easier to obtain than intraoperative cultures, this method raises the possibility of a suboptimal treatment protocol in case of discordant cultures [ 86 , 90 , 91 , 92 ].…”

A Complicated Case of Rheumatoid Arthritis in Septic Shock

“…The result of the patient's aspirated culture was negative. Intraoperative synovial fluid culture can identify pathogens in about 20% of culture-negative patients [14]. This was eventually required in the patient because the synovial fluid culture result was negative.…”