Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection.

Abstract

During a two-stage revision for prosthetic joint infections (PJI), joint aspirations, open tissue sampling and serum inflammatory markers are performed before re-implantation to exclude ongoing silent infection. We investigated the performance of these diagnostic procedures on the risk of recurrence of PJI among asymptomatic patients undergoing a two-stage revision. A total of 62 PJI were found in 58 patients. All patients had intra-operative surgical exploration during re-implantation, and 48 of them had intra-operative microbiological swabs. Additionally, 18 joint aspirations and one open biopsy were performed before second-stage reimplantation. Recurrence or persistence of PJI occurred in 12 cases with a mean delay of 218 days after re-implantation, but only four pre- or intraoperative invasive joint samples had grown a pathogen in cultures. In at least seven recurrent PJIs (58%), patients had a normal C-reactive protein (CRP, < 10 mg/l) level before re-implantation. The sensitivity, specificity, positive predictive and negative predictive values of pre-operative invasive joint aspiration and CRP for the prediction of PJI recurrence was 0.58, 0.88, 0.5, 0.84 and 0.17, 0.81, 0.13, 0.86, respectively. As a conclusion, pre-operative joint aspiration, intraoperative bacterial sampling, surgical exploration and serum inflammatory markers are poor predictors of PJI recurrence. The onset of reinfection usually occurs far later than reimplantation.

• Authors: Maximilian Schindler, Panayiotis Christofilopoulos, Blaise Wyssa, Wilson Belaieff, Christian Garzoni, Louis Bernard, Daniel Lew, Pierre Hoffmeyer, Ilker Uçkay
• Journal: International orthopaedics (Int Orthop) Vol. 35 Issue 5 Pg. 647-54 (May 2011) ISSN: 1432-5195 [Electronic] Germany
• PMID: 20419507 (Publication Type: Journal Article)

Chemical References

• C-Reactive Protein

Topics

• Adult
• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip (adverse effects)
• Arthroplasty, Replacement, Knee (adverse effects)
• Bacteriological Techniques
• C-Reactive Protein (analysis)
• False Negative Reactions
• False Positive Reactions
• Female
• Hip Joint (microbiology, surgery)
• Humans
• Intraoperative Period
• Knee Joint (microbiology, surgery)
• Male
• Middle Aged
• Predictive Value of Tests
• Prosthesis-Related Infections (blood, diagnosis, microbiology)
• Recurrence
• Reoperation
• Retrospective Studies
• Suction (methods)