Think Twice before Prescribing Antibiotics for That Swollen Knee: The Influence of Antibiotics on the Diagnosis of Periprosthetic Joint Infection

Abstract

Periprosthetic joint infection (PJI) is a rare but devastating complication after total joint arthroplasty. An estimated 7–12% of patients have negative cultures despite clear clinical evidence of infection. One oft-cited reason for this occurrence is the administration of antibiotics in the weeks prior to obtaining cultures. This article reviews the influence of antibiotics on the diagnosis of PJI. Specifically, we examine the effect of prophylactic and therapeutic antibiotic administration on the diagnostic accuracy of microbiological cultures as well as serum and synovial biomarkers. We also explore the potential of molecular techniques in overcoming these limitations in patients who have received antibiotics before specimen collection and propose areas for future research.

Is There a Difference in Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Fracture-Related Infection and Periprosthetic Joint Infection? A Retrospective Comparative Study

“…Moreover, higher rates of polymicrobial infections in FRI have been described comparing different sampling protocols (25% and 36%, respectively) [ 12 ]. The present rate of culture-negative PJIs (13.6%) was similar to previous reports indicating a proportion of 5% to 12% [ 13 , 14 ]. Differences in reported polymicrobial and culture-negative PJI rates might be due to local epidemiology and different diagnostic criteria used for PJI and FRI as well as previous antibiotic treatment, which decreases microbial diagnostic yield [ 15 , 16 ].…”

Retrospective evaluation of 103 cases of septic arthritis in dogs

“…8,11,15 Furthermore, human studies have found that inappropriate antibiotic therapy can render many pathogens viable but non-culturable, thus yielding a falsely negative culture. 5,[20][21][22] However, administration of perioperative prophylactic antibiotics has been shown to not have an effect on culture results in several studies. [21][22][23] It remains debatable whether culturing synovial fluid or synovial membrane improves the diagnostic yield of infected joints.…”

“…5,[20][21][22] However, administration of perioperative prophylactic antibiotics has been shown to not have an effect on culture results in several studies. [21][22][23] It remains debatable whether culturing synovial fluid or synovial membrane improves the diagnostic yield of infected joints. Studies in dogs, horses and humans with SA have found synovial fluid culture to be significantly more reliable in yielding bacterial growth compared with synovial membrane.…”

“…Pre-emptive antibiotics not only significantly increase the risk of a negative culture, but they also result in less targeted antibiotic therapy and unacceptable levels of treatment failure (31%). 21,23 It has also been demonstrated that failure of first line antibiotic therapy increases the risk of a poor outcome in humans. 35 Although our findings do not support that outcome is negatively affected by pre-emptive antibiosis prior to synovial fluid culture, the authors recommend obtaining a synovial fluid sample for culture before starting empiric antibiotic therapy when possible.…”

Antibiotics in Orthopedic Infections

“…In their review work, Goh and Parvizi reported on the influence of antibiotics on the diagnosis of PJI [ 10 ]. The effect of prophylactic and therapeutic antibiotic administration on the diagnostic accuracy of microbiological cultures and serum or synovial biomarkers is presented.…”