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Tytuł pozycji:

The James A. Rand Young Investigator's Award: Are Intraoperative Cultures Necessary If the Aspiration Culture Is Positive? A Concordance Study in Periprosthetic Joint Infection.

Tytuł:
The James A. Rand Young Investigator's Award: Are Intraoperative Cultures Necessary If the Aspiration Culture Is Positive? A Concordance Study in Periprosthetic Joint Infection.
Autorzy:
Boyle KK; Department of Orthopaedics, Joint Replacement & Reconstruction, University at Buffalo, SUNY, Buffalo, NY.
Kapadia M; Department of Infectious Diseases, Hospital for Special Surgery, New York, NY.
Chiu YF; Healthcare Research Institute, Hospital for Special Surgery, New York, NY.
Khilnani T; Weill Cornell Medical College, New York, NY.
Miller AO; Department of Infectious Diseases, Hospital for Special Surgery, New York, NY.
Henry MW; Department of Infectious Diseases, Hospital for Special Surgery, New York, NY.
Lyman S; Healthcare Research Institute, Hospital for Special Surgery, New York, NY; Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY.
Carli AV; Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY.
Źródło:
The Journal of arthroplasty [J Arthroplasty] 2021 Jul; Vol. 36 (7S), pp. S4-S10. Date of Electronic Publication: 2021 Feb 02.
Typ publikacji:
Journal Article
Język:
English
Imprint Name(s):
Publication: New Brunswick, NJ : Taylor and Francis
Original Publication: [New York, NY : Churchill Livingstone, c1986-
MeSH Terms:
Arthritis, Infectious*
Arthroplasty, Replacement, Hip*/adverse effects
Awards and Prizes*
Prosthesis-Related Infections*/diagnosis
Prosthesis-Related Infections*/surgery
Humans ; Reoperation ; Retrospective Studies ; Sensitivity and Specificity ; Synovial Fluid
Contributed Indexing:
Keywords: culture concordance; culture discordance; periprosthetic hip infection; periprosthetic joint infection; periprosthetic knee infection
Entry Date(s):
Date Created: 20210307 Date Completed: 20210630 Latest Revision: 20210630
Update Code:
20240104
DOI:
10.1016/j.arth.2021.01.073
PMID:
33676815
Czasopismo naukowe
Background: The concordance between preoperative synovial fluid culture and multiple intraoperative tissue cultures for identifying pathogenic microorganisms in periprosthetic joint infection (PJI) remains unknown. Our aim is to determine the diagnostic performance of synovial fluid culture for early organism identification.
Methods: A total of 363 patients who met Musculoskeletal Infection Society criteria for PJI following primary total joint arthroplasty were identified from a retrospective joint infection database. Inclusion criteria required a positive preoperative intra-articular synovial fluid sample within 90 days of intraoperative tissue culture(s) at revision surgery. Concordance was defined as matching organism(s) in aspirate and intraoperative specimens.
Results: Concordance was identified in 279 (76.8%) patients with similar rates among total hip arthroplasties (77.2%) and total knee arthroplasties (76.4%, P = .86). Culture discordance occurred in 84 (23.1%) patients; 37 (10.2%) had no intraoperative culture growth and 33 (90.1%) were polymicrobial. Monomicrobial Staphylococcal PJI cases had high sensitivity (0.96, 95% confidence interval [CI] 0.92-0.98) and specificity (0.85, 95% CI 0.80-0.90). Polymicrobial infections had the lowest sensitivity (0.06, 95% CI 0.01-0.19).
Conclusion: Aspiration culture has favorable sensitivity and specificity when compared to tissue culture for identifying the majority of PJI organisms. Clinicians can guide surgical treatment and postoperative antibiotics based on monomicrobial aspiration results, but they should strongly consider collecting multiple tissue cultures to maximize the chance of identifying an underlying polymicrobial PJI.
Level of Evidence: Level III.
(Copyright © 2021 Elsevier Inc. All rights reserved.)

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