Unnecessary Routine Use of Mycobacterial Cultures in Patients With Periprosthetic Joint Infections

Golden, Marjorie; Moffarah, Anne Spichler; Kerantzas, Christopher A.; Rubin, Lee E.; O’Bryan, Jane

doi:10.1093/ofid/ofac132

Cited by 3 publications

(1 citation statement)

References 16 publications

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“…Golden et al suggested that routine testing was unnecessary and in fact an inappropriate use of laboratory resources given the shortage of microbiology technologists during the coronavirus 2019 pandemic. 23 Tokarski et al found that despite a positivity rate of 0.5% for AFB cultures and 1.7% for fungal cultures, costs exceeded more than $1.3 million dollars in testing. 7 It has been noted that typical clinical pathogens can be grown and identified within 24 to 48 hours, 24 while fungal infections can be extremely difficult to diagnose and may take as long as 2 weeks to grow.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors for Acid-fast Bacillus/Fungal Culture Positivity in Primary, Conversion, and Revision Hip and Knee Arthroplasty

Oetojo,

Feffer,

Wesolowski

et al. 2024

J Am Acad Orthop Surg

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Introduction: Previous literature has reported minimal incidences of positive fungal/AFB cultures, questioning the routine use of these tests. With growing concern for excessive use, predictive factors for patients at higher risk for intraoperative AFB/fungal infections would help surgeons limit unnecessary testing. This study evaluates the positivity rate and predictive factors of positive fungal and/or acid-fast bacillus (AFB) cultures after primary, conversion, or revision hip and knee arthroplasty. Method: Two hundred thirty-eight knee and hip procedures were done between January 2007 and 2022 where intraoperative AFB/fungal cultures were obtained. Procedures included primary total knee arthroplasty, primary total hip arthroplasty, conversion, first of two-stage, second of two-stage, irrigation and débridement polyexchange, and aseptic revision. Positivity rates of intraoperative AFB/fungal cultures were calculated as binomial exact proportions with 95% confidence intervals and are displayed as percentages. Univariable generalized linear mixed models estimated the unadjusted effects of demographics, individual comorbid conditions, and procedural characteristics on the logit of positive AFB/fungal cultures. Results: Two hundred thirty-eight knee and hip procedures recorded an overall positivity rate of 5.8% for intraoperative AFB/fungal cultures. Aseptic revisions showed the lowest rates of positivity at 3.6%, while conversions showed the highest rates of positivity at 14.3%. The positivity rates are highest among patients who are male (9.0%), of Hispanic origin (12.0%), with body mass index <30 (6.4%), and a Charlson Comorbidity Index <5 (6.1%). History of a prior infection in the same surgical joint showed statistically significant influence of odds of culture positivity with an odds ratio of 3.47 (P-value: 0.039). Other demographic factors that we investigated including age, sex, race, ethnicity, body mass index, and Charlson Comorbidity Index did not show any notable influence on AFB/fungal positivity rates. Conclusion: These results suggest utility in obtaining routine intraoperative AFB/fungal cultures, given the relatively high positivity and poor predictive factors.

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Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors for Acid-fast Bacillus/Fungal Culture Positivity in Primary, Conversion, and Revision Hip and Knee Arthroplasty

Oetojo,

Feffer,

Wesolowski

et al. 2024

J Am Acad Orthop Surg

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Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections

Azad,

Patel

2024

Clin Microbiol Rev

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SUMMARY Implant-associated infections (IAIs) pose serious threats to patients and can be associated with significant morbidity and mortality. These infections may be difficult to diagnose due, in part, to biofilm formation on device surfaces, and because even when microbes are found, their clinical significance may be unclear. Despite recent advances in laboratory testing, IAIs remain a diagnostic challenge. From a therapeutic standpoint, many IAIs currently require device removal and prolonged courses of antimicrobial therapy to effect a cure. Therefore, making an accurate diagnosis, defining both the presence of infection and the involved microorganisms, is paramount. The sensitivity of standard microbial culture for IAI diagnosis varies depending on the type of IAI, the specimen analyzed, and the culture technique(s) used. Although IAI-specific culture-based diagnostics have been described, the challenge of culture-negative IAIs remains. Given this, molecular assays, including both nucleic acid amplification tests and next-generation sequencing-based assays, have been used. In this review, an overview of these challenging infections is presented, as well as an approach to their diagnosis from a microbiologic perspective.

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Yield of routine mycobacterial culture of osteoarticular specimens in a tertiary orthopaedic hospital in England, 2017–2022

Yates,

Vahesan,

Warren

et al. 2024

J. Bone Joint Infect.

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Abstract. Introduction: At our tertiary orthopaedic centre, mycobacterial cultures are routinely performed on bone and joint samples sent for bacterial culture. Methods: From laboratory records, we ascertained the number of mycobacterial cultures performed, the number positive for Mycobacterium tuberculosis complex (MTBC) and/or non-tuberculous mycobacteria (NTM), and the characteristics of individuals from whom mycobacteria were isolated. We collected the same data from 100 individuals with negative mycobacterial cultures. Results: Excluding sample types that were not bone or joint samples, 6162 mycobacterial cultures were performed between 4 July 2017 and 30 September 2022. A total of 22 patients had MTBC and 6 patients had NTM newly isolated from bone or joint samples placed in mycobacterial culture, while a further 1 patient had both Mycobacterium tuberculosis and Mycobacterium avium isolated. To identify one new mycobacterial infection of bone or joint (MTBC or NTM) that would not have been detected with routine bacterial cultures alone, 229 (95 % CI of 158–347) mycobacterial cultures were needed. Mycobacterial cultures were much less likely to be positive in samples taken from prosthetic joints. They were more likely to be positive in spinal samples and in samples taken from patients with suspected sarcoma. In patients from whom MTBC had been isolated, granulomatous inflammation was reported in 86 % (18 of 21) of contemporaneous histological specimens. Conclusions: Targeted, rather than routine, mycobacterial culture of bone and joint specimens should be considered in settings with a low burden of tuberculosis.

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Unnecessary Routine Use of Mycobacterial Cultures in Patients With Periprosthetic Joint Infections

Cited by 3 publications

References 16 publications

Incidence and Risk Factors for Acid-fast Bacillus/Fungal Culture Positivity in Primary, Conversion, and Revision Hip and Knee Arthroplasty

Incidence and Risk Factors for Acid-fast Bacillus/Fungal Culture Positivity in Primary, Conversion, and Revision Hip and Knee Arthroplasty

Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections

Yield of routine mycobacterial culture of osteoarticular specimens in a tertiary orthopaedic hospital in England, 2017–2022

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