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Diagnosis and Treatment of Culture-Negative Periprosthetic Joint Infection
Authors/contributors
- Goh, Graham S. (Author)
- Parvizi, Javad (Author)
Abstract
Identification of the causative organism(s) in periprosthetic joint infection (PJI) is a challenging task. The shortcomings of traditional cultures have been emphasized in recent literature, culminating in a clinical entity known as “culture-negative PJI.” Amidst the growing burden of biofilm infections that are inherently difficult to culture, the field of clinical microbiology has seen a paradigm shift from culture-based to molecular-based methods. These novel techniques hold much promise in the demystification of culture-negative PJI and revolutionization of the microbiology laboratory. This article outlines the clinical implications of culture-negative PJI, common causes of this diagnostic conundrum, established strategies to improve culture yield, and newer molecular techniques to detect infectious organisms.
Publication
The Journal of Arthroplasty
Date
08/2022
Notes
Key findings:
- Approximately 20%-50% of patients with clinical and laboratory evidence of PJI have negative cultures, leading to a diagnostic challenge known as "culture-negative PJI."
- Culture-negative PJI can result in higher rates of treatment failure. Empiric treatment involves broad-spectrum antimicrobials, risking systemic toxicity and contributing to antimicrobial resistance.
- Antibiotic treatment before sampling, introduction of bacteriostatic substances during the procedure, and inadequate incubation time are common causes of CN PJI.
- Strategies to improve culture yield include obtaining multiple intraoperative samples, sonication, extending incubation periods, using specialized media for atypical organisms, and avoiding swab cultures.
- Molecular methods, such as multiplex PCR, 16S rRNA gene sequencing, NGS, MG-NGS, and MT-NGS, offer improved sensitivity compared to traditional culture methods. Challenges include the need for specific primers, potential detection of DNA in non-infected joints, and difficulty distinguishing between active and treated infections.
Clinical implications/strengths:
- Topic review of culture negative PJI
Limitations:
-
Review article
Level of evidence: Low (symposium review article)
Citation
1.
Goh GS, Parvizi J. Diagnosis and Treatment of Culture-Negative Periprosthetic Joint Infection. The Journal of Arthroplasty. 2022;37(8):1488-1493.
Section
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