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

Schindler, Maximilian; Christofilopoulos, Panayiotis; Wyssa, Blaise Jean Albert; Belaieff, Wilson; Garzoni, Christian; Bernard, Louis; Lew, Daniel Pablo; Hoffmeyer, Pierre; Uckay, Ilker

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Title		Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection
Authors		Schindler, Maximilian Christofilopoulos, Panayiotis Wyssa, Blaise Jean Albert Belaieff, Wilson Garzoni, Christian Bernard, Louis Lew, Daniel Pablo Hoffmeyer, Pierre Uckay, Ilker show all authors [1 - 9]
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		DOI: 10.1007/s00264-010-1014-8 PMID: 20419507
Full text		Article (Published version) (139 Kb) - Free access
Structures		Faculté de médecine / Section de médecine clinique / Département de médecine interne des spécialités Faculté de médecine / Section de médecine clinique / Département de chirurgie
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. https://archive-ouverte.unige.ch/unige:24859