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Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection |
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Published in | International Orthopaedics. 2011, vol. 35, no. 5, p. 647-54 | |
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. | |
Keywords | 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 | |
Identifiers | PMID: 20419507 | |
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Research groups | Chirurgie orthopédique et traumatologique (98) Glycopeptide résistance (28) | |
Citation (ISO format) | SCHINDLER, Maximilian et al. Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection. In: International Orthopaedics, 2011, vol. 35, n° 5, p. 647-54. doi: 10.1007/s00264-010-1014-8 https://archive-ouverte.unige.ch/unige:24859 |