nach oben

International Orthopaedics

Erschienen in:

24.05.2020 | Review Article

Culture-negative periprosthetic joint infection: prevalence, aetiology, evaluation, recommendations, and treatment

verfasst von: Irene Kalbian, Jung Wee Park, Karan Goswami, Young-Kyun Lee, Javad Parvizi, Kyung-Hoi Koo

Erschienen in: International Orthopaedics | Ausgabe 7/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Periprosthetic joint infection (PJI) is a catastrophic complication after total joint arthroplasty (TJA). Treatment of PJI is challenging, especially when causative microorganism is not identified. The purpose of this systematic review was to guide diagnostic approach and treatment of culture-negative (CN) PJI.

Methods

A systematic review was undertaken on clinical studies from MEDLINE, EMBASE, Cochrane Library, and Scopus databases. Basic science studies, letters, studies written in languages other than English, case reports, and review articles were excluded.

Results

Proportion of CN PJI ranged from 5 to 42% of PJIs. Risk factors for culture negativity included prior use of antibiotic before culture test, inappropriate culture tools, insufficient culture period, and post-operative wound drainage. Specific diagnostic protocols including repeating sampling, longer incubation period, culture in blood culture bottles, sonication of implants, polymerase chain reaction in synovial fluid, and next-generation sequencing are recommended to identify undetected microorganisms. Vancomycin and cephalosporins are the most commonly used antibiotics. Two-stage revision arthroplasty showed success rate of 70–100%.

Conclusions

A comprehensive review was performed to provide an up-to-date, evidence-based guide to the management of CN PJI.

Nur mit Berechtigung zugänglich

Yoon H-K, Cho S-H, Lee D-Y, Kang B-H, Lee S-H, Moon D-G et al (2017) A review of the literature on culture-negative periprosthetic joint infection: epidemiology, diagnosis and treatment. Knee Surg Relat Res 29:155–164. https://doi.org/10.5792/ksrr.16.034 CrossRefPubMedPubMedCentral

Aggarwal VK, Bakhshi H, Ecker NU, Parvizi J, Gehrke T, Kendoff D (2014) Organism profile in periprosthetic joint infection: pathogens differ at two arthroplasty infection referral centers in Europe and in the United States. J Knee Surg 27:399–406. https://doi.org/10.1055/s-0033-1364102 CrossRefPubMed

Ibrahim MS, Twaij H, Haddad FS (2018) Two-stage revision for the culture-negative infected total hip arthroplasty: a comparative study. Bone Jt J 100-B:3–8. https://doi.org/10.1302/0301-620X.100B1.BJJ-2017-0626.R1 CrossRef

Kim Y-H, Kulkarni SS, Park J-W, Kim J-S, Oh H-K, Rastogi D (2015) Comparison of infection control rates and clinical outcomes in culture-positive and culture-negative infected total-knee arthroplasty. J Orthop 12:S37–S43. https://doi.org/10.1016/j.jor.2015.01.020 CrossRefPubMedPubMedCentral

Li H, Ni M, Li X, Zhang Q, Li X, Chen J (2017) Two-stage revisions for culture-negative infected total knee arthroplasties: a five-year outcome in comparison with one-stage and two-stage revisions for culture-positive cases. J Orthop Sci Off J Jpn Orthop Assoc 22:306–312. https://doi.org/10.1016/j.jos.2016.11.008 CrossRef

Malekzadeh D, Osmon DR, Lahr BD, Hanssen AD, Berbari EF (2010) Prior use of antimicrobial therapy is a risk factor for culture-negative prosthetic joint infection. Clin Orthop 468:2039–2045. https://doi.org/10.1007/s11999-010-1338-0 CrossRefPubMed

Berbari EF, Marculescu C, Sia I, Lahr BD, Hanssen AD, Steckelberg JM et al (2007) Culture-negative prosthetic joint infection. Clin Infect Dis Off Publ Infect Dis Soc Am 45:1113–1119. https://doi.org/10.1086/522184 CrossRef

Choi H-R, Kwon Y-M, Freiberg AA, Nelson SB, Malchau H (2013) Periprosthetic joint infection with negative culture results: clinical characteristics and treatment outcome. J Arthroplast 28:899–903. https://doi.org/10.1016/j.arth.2012.10.022 CrossRef

Huang R, Hu C-C, Adeli B, Mortazavi J, Parvizi J (2012) Culture-negative periprosthetic joint infection does not preclude infection control. Clin Orthop 470:2717–2723. https://doi.org/10.1007/s11999-012-2434-0 CrossRefPubMed

10.

Bejon P, Berendt A, Atkins BL, Green N, Parry H, Masters S et al (2010) Two-stage revision for prosthetic joint infection: predictors of outcome and the role of reimplantation microbiology. J Antimicrob Chemother 65:569–575. https://doi.org/10.1093/jac/dkp469 CrossRefPubMedPubMedCentral

11.

Tan TL, Kheir MM, Shohat N, Tan DD, Kheir M, Chen C et al (2018) Culture-negative periprosthetic joint infection: an update on what to expect. JBJS Open Access 3:e0060. https://doi.org/10.2106/JBJS.OA.17.00060 CrossRefPubMedPubMedCentral

12.

Trampuz A, Piper KE, Hanssen AD, Osmon DR, Cockerill FR, Steckelberg JM et al (2006) Sonication of explanted prosthetic components in bags for diagnosis of prosthetic joint infection is associated with risk of contamination. J Clin Microbiol 44:628–631. https://doi.org/10.1128/JCM.44.2.628-631.2006 CrossRefPubMedPubMedCentral

13.

Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR et al (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357:654–663. https://doi.org/10.1056/NEJMoa061588 CrossRefPubMed

14.

Parvizi J, Ghanem E, Sharkey P, Aggarwal A, Burnett RSJ, Barrack RL (2008) Diagnosis of infected total knee: findings of a multicenter database. Clin Orthop 466:2628–2633. https://doi.org/10.1007/s11999-008-0471-5 CrossRefPubMed

15.

Parvizi J, Erkocak OF, Della Valle CJ (2014) Culture-negative periprosthetic joint infection. J Bone Jt Surg-Am Vol 96:430–436. https://doi.org/10.2106/JBJS.L.01793 CrossRef

16.

Million M, Bellevegue L, Labussiere A-S, Dekel M, Ferry T, Deroche P et al (2014) Culture-negative prosthetic joint arthritis related to Coxiella burnetii. Am J Med 127:786.e7–786.e10. https://doi.org/10.1016/j.amjmed.2014.03.013 CrossRef

17.

Parikh MS, Antony S (2016) A comprehensive review of the diagnosis and management of prosthetic joint infections in the absence of positive cultures. J Infect Public Health 9:545–556. https://doi.org/10.1016/j.jiph.2015.12.001 CrossRefPubMed

18.

Goswami K, Parvizi J, Maxwell CP (2018) Current recommendations for the diagnosis of acute and chronic PJI for hip and knee—cell counts, alpha-defensin, leukocyte esterase, next-generation sequencing. Curr Rev Musculoskelet Med 11:428–438. https://doi.org/10.1007/s12178-018-9513-0 CrossRefPubMedPubMedCentral

19.

Azzam K, Parvizi J, Jungkind D, Hanssen A, Fehring T, Springer B et al (2009) Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience. J Bone Joint Surg Am 91(Suppl 6):142–149. https://doi.org/10.2106/JBJS.I.00574 CrossRefPubMed

20.

Zimmerli W, Waldvogel FA, Vaudaux P, Nydegger UE (1982) Pathogenesis of foreign body infection: description and characteristics of an animal model. J Infect Dis 146:487–497. https://doi.org/10.1093/infdis/146.4.487 CrossRefPubMed

21.

Costerton JW, Lewandowski Z, Caldwell DE, Korber DR, Lappin-Scott HM (1995) Microbial biofilms. Annu Rev Microbiol 49:711–745. https://doi.org/10.1146/annurev.mi.49.100195.003431 CrossRefPubMed

22.

Stewart PS, Costerton JW (2001) Antibiotic resistance of bacteria in biofilms. Lancet Lond Engl 358:135–138. https://doi.org/10.1016/s0140-6736(01)05321-1 CrossRef

23.

Kim S-J, Kim JH (2013) Late onset Mycobacterium tuberculosis infection after total knee arthroplasty: a systematic review and pooled analysis. Scand J Infect Dis 45:907–914. https://doi.org/10.3109/00365548.2013.830192 CrossRefPubMed

24.

Abdulmassih R, Makadia J, Como J, Paulson M, Min Z, Bhanot N (2016) Propionibacterium acnes: time-to-positivity in standard bacterial culture from different anatomical sites. J Clin Med Res 8:916–918. https://doi.org/10.14740/jocmr2753w CrossRefPubMedPubMedCentral

25.

Meermans G, Haddad FS (2010) Is there a role for tissue biopsy in the diagnosis of periprosthetic infection? Clin Orthop 468:1410–1417. https://doi.org/10.1007/s11999-010-1245-4 CrossRefPubMed

26.

Schäfer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L (2008) Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis Off Publ Infect Dis Soc Am 47:1403–1409. https://doi.org/10.1086/592973 CrossRef

27.

Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF et al (2018) The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 33:1309–1314.e2. https://doi.org/10.1016/j.arth.2018.02.078 CrossRefPubMed

28.

Shahi A, Parvizi J, Kazarian GS, Higuera C, Frangiamore S, Bingham J et al (2016) The alpha-defensin test for periprosthetic joint infections is not affected by prior antibiotic administration. Clin Orthop 474:1610–1615. https://doi.org/10.1007/s11999-016-4726-2 CrossRefPubMed

29.

Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Parvizi J (2014) Combined measurement of synovial fluid α-Defensin and C-reactive protein levels: highly accurate for diagnosing periprosthetic joint infection. J Bone Joint Surg Am 96:1439–1445. https://doi.org/10.2106/JBJS.M.01316 CrossRefPubMed

30.

Frangiamore SJ, Gajewski ND, Saleh A, Farias-Kovac M, Barsoum WK, Higuera CA (2016) α-Defensin accuracy to diagnose periprosthetic joint infection-best available test? J Arthroplast 31:456–460. https://doi.org/10.1016/j.arth.2015.09.035 CrossRef

31.

Lee YS, Lee Y-K, Han SB, Nam CH, Parvizi J, Koo K-H (2018) Natural progress of D-dimer following total joint arthroplasty: a baseline for the diagnosis of the early postoperative infection. J Orthop Surg 13:36. https://doi.org/10.1186/s13018-018-0730-4 CrossRef

32.

Shahi A, Kheir MM, Tarabichi M, Hosseinzadeh HRS, Tan TL, Parvizi J (2017) Serum D-dimer test Is promising for the diagnosis of periprosthetic joint infection and timing of reimplantation. J Bone Jt Surg 99:1419–1427. https://doi.org/10.2106/JBJS.16.01395 CrossRef

33.

Della Valle C, Parvizi J, Bauer TW, Dicesare PE, Evans RP, Segreti J et al (2010) Diagnosis of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg 18:760–770CrossRef

34.

Zmistowski B, Della Valle C, Bauer TW, Malizos KN, Alavi A, Bedair H et al (2014) Diagnosis of periprosthetic joint infection. J Arthroplast 29:77–83. https://doi.org/10.1016/j.arth.2013.09.040 CrossRef

35.

Basu S, Bose C, Ojha N, Das N, Das J, Pal M et al (2015) Evolution of bacterial and fungal growth media. Bioinformation 11:182–184. https://doi.org/10.6026/97320630011182 CrossRefPubMedPubMedCentral

36.

Saleeb PG, Drake SK, Murray PR, Zelazny AM (2011) Identification of mycobacteria in solid-culture media by matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol 49:1790–1794. https://doi.org/10.1128/JCM.02135-10 CrossRefPubMedPubMedCentral

37.

Zappe B, Graf S, Ochsner PE, Zimmerli W, Sendi P (2008) Propionibacterium spp. in prosthetic joint infections: a diagnostic challenge. Arch Orthop Trauma Surg 128:1039–1046. https://doi.org/10.1007/s00402-007-0454-0 CrossRefPubMed

38.

Font-Vizcarra L, García S, Martínez-Pastor JC, Sierra JM, Soriano A (2010) Blood culture flasks for culturing synovial fluid in prosthetic joint infections. Clin Orthop 468:2238–2243. https://doi.org/10.1007/s11999-010-1254-3 CrossRefPubMed

39.

Barrack RL, Jennings RW, Wolfe MW, Bertot AJ (1997) The Coventry Award. The value of preoperative aspiration before total knee revision. Clin Orthop:8–16

40.

Tarabichi M, Shohat N, Goswami K, Alvand A, Silibovsky R, Belden K et al (2018) Diagnosis of periprosthetic joint infection: the potential of next-generation sequencing. J Bone Joint Surg Am 100:147–154. https://doi.org/10.2106/JBJS.17.00434 CrossRefPubMed

41.

Melendez DP, Uhl JR, Greenwood-Quaintance KE, Hanssen AD, Sampath R, Patel R (2014) Detection of prosthetic joint infection by use of PCR-electrospray ionization mass spectrometry applied to synovial fluid. J Clin Microbiol 52:2202–2205. https://doi.org/10.1128/JCM.00570-14 CrossRefPubMedPubMedCentral

42.

Portillo ME, Salvadó M, Sorli L, Alier A, Martínez S, Trampuz A et al (2012) Multiplex PCR of sonication fluid accurately differentiates between prosthetic joint infection and aseptic failure. J Inf Secur 65:541–548. https://doi.org/10.1016/j.jinf.2012.08.018 CrossRef

43.

Hartley JC, Harris KA (2014) Molecular techniques for diagnosing prosthetic joint infections. J Antimicrob Chemother 69(Suppl 1):i21–i24. https://doi.org/10.1093/jac/dku249 CrossRefPubMed

44.

Khot PD, Ko DL, Fredricks DN (2009) Sequencing and analysis of fungal rRNA operons for development of broad-range fungal PCR assays. Appl Environ Microbiol 75:1559–1565. https://doi.org/10.1128/AEM.02383-08 CrossRefPubMedPubMedCentral

45.

Clarridge JE (2004) Impact of 16S rRNA gene sequence analysis for identification of bacteria on clinical microbiology and infectious diseases. Clin Microbiol Rev 17:840–862, table of contents. https://doi.org/10.1128/CMR.17.4.840-862.2004 CrossRefPubMedPubMedCentral

46.

Goldberg B, Sichtig H, Geyer C, Ledeboer N, Weinstock GM (2015) Making the leap from research laboratory to clinic: challenges and opportunities for next-generation sequencing in infectious disease diagnostics. MBio 6:e01888–e01815. https://doi.org/10.1128/mBio.01888-15 CrossRefPubMedPubMedCentral

47.

Dunne WM, Westblade LF, Ford B (2012) Next-generation and whole-genome sequencing in the diagnostic clinical microbiology laboratory. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol 31:1719–1726. https://doi.org/10.1007/s10096-012-1641-7 CrossRef

48.

Tarabichi M, Shohat N, Goswami K, Parvizi J (2018) Can next generation sequencing play a role in detecting pathogens in synovial fluid? Bone Jt J 100-B:127–133. https://doi.org/10.1302/0301-620X.100B2.BJJ-2017-0531.R2 CrossRef

49.

Tarabichi M, Alvand A, Shohat N, Goswami K, Parvizi J (2018) Diagnosis of Streptococcus canis periprosthetic joint infection: the utility of next-generation sequencing. Arthroplasty Today 4:20–23. https://doi.org/10.1016/j.artd.2017.08.005 CrossRefPubMed

50.

Thoendel MJ, Jeraldo PR, Greenwood-Quaintance KE, Yao JZ, Chia N, Hanssen AD et al (2018) Identification of prosthetic joint infection pathogens using a shotgun metagenomics approach. Clin Infect Dis Off Publ Infect Dis Soc Am 67:1333–1338. https://doi.org/10.1093/cid/ciy303 CrossRef

51.

Drago L, Signori V, De Vecchi E, Vassena C, Palazzi E, Cappelletti L et al (2013) Use of dithiothreitol to improve the diagnosis of prosthetic joint infections. J Orthop Res Off Publ Orthop Res Soc 31:1694–1699. https://doi.org/10.1002/jor.22423 CrossRef

52.

De Vecchi E, Bortolin M, Signori V, Romanò CL, Drago L (2016) Treatment with dithiothreitol improves bacterial recovery from tissue samples in osteoarticular and joint infections. J Arthroplast 31:2867–2870. https://doi.org/10.1016/j.arth.2016.05.008 CrossRef

53.

Hartman MB, Fehring TK, Jordan L, Norton HJ (1991) Periprosthetic knee sepsis. The role of irrigation and debridement. Clin Orthop:113–118

54.

Thakrar RR, Horriat S, Kayani B, Haddad FS (2019) Indications for a single-stage exchange arthroplasty for chronic prosthetic joint infection: a systematic review. Bone Jt J 101-B:19–24. https://doi.org/10.1302/0301-620X.101B1.BJJ-2018-0374.R1 CrossRef

55.

Kim Y-H, Park J-W, Kim J-S, Kim D-J (2015) The outcome of infected total knee arthroplasty: culture-positive versus culture-negative. Arch Orthop Trauma Surg 135:1459–1467. https://doi.org/10.1007/s00402-015-2286-7 CrossRefPubMed

56.

Lee Y-K, Lee KH, Nho J-H, Ha Y-C, Koo K-H (2013) Retaining well-fixed cementless stem in the treatment of infected hip arthroplasty. Acta Orthop 84:260–264. https://doi.org/10.3109/17453674.2013.795830 CrossRefPubMedPubMedCentral

57.

Koo KH, Yang JW, Cho SH, Song HR, Park HB, Ha YC et al (2001) Impregnation of vancomycin, gentamicin, and cefotaxime in a cement spacer for two-stage cementless reconstruction in infected total hip arthroplasty. J Arthroplast 16:882–892. https://doi.org/10.1054/arth.2001.24444 CrossRef

58.

McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M (2002) Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop:8–15

59.

Leung F, Richards CJ, Garbuz DS, Masri BA, Duncan CP (2011) Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection? Clin Orthop 469:1009–1015. https://doi.org/10.1007/s11999-010-1725-6 CrossRefPubMed

60.

Abdel MP, Barreira P, Battenberg A, Berry DJ, Blevins K, Font-Vizcarra L et al (2019) Hip and knee section, treatment, two-stage exchange spacer-related: proceedings of international consensus on orthopedic infections. J Arthroplasty 34:S427–S438. https://doi.org/10.1016/j.arth.2018.09.027 CrossRefPubMed

Titel: Culture-negative periprosthetic joint infection: prevalence, aetiology, evaluation, recommendations, and treatment
verfasst von: Irene Kalbian
Jung Wee Park
Karan Goswami
Young-Kyun Lee
Javad Parvizi
Kyung-Hoi Koo
Publikationsdatum: 24.05.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 7/2020
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04627-5

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Culture-negative periprosthetic joint infection: prevalence, aetiology, evaluation, recommendations, and treatment

Abstract

Purpose

Methods

Results

Conclusions

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

Fehlerkultur in der Medizin – Offenheit zählt!

Mehr Frauen im OP – weniger postoperative Komplikationen

Update Orthopädie und Unfallchirurgie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2020

Randomized controlled trial of chlorhexidine wash versus benzoyl peroxide soap for home surgical preparation: neither is effective in removing Cutibacterium from the skin of shoulder arthroplasty patients

Simultaneous single-stage versus two-staged bilateral total knee arthroplasty: a prospective comparative study

Answer letter concerning “Comparison of posterior ring fixation with combined anterior and posterior ring fixation for the treatment of lateral compression type 2 pelvic fractures”

Personality traits predict residual pain after total hip and knee arthroplasty

The initial treatment of complex proximal humerus fracture affects the outcome of revision with reverse shoulder arthroplasty

The effects of length of femoral stem on aseptic loosening following cemented distal femoral endoprosthetic replacement in tumour surgery

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

Fehlerkultur in der Medizin – Offenheit zählt!

Mehr Frauen im OP – weniger postoperative Komplikationen

Update Orthopädie und Unfallchirurgie