Scientific article
OA Policy
English

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

Published inInternational orthopaedics, vol. 35, no. 5, p. 647-654
Publication date2011
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
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. 647–654. doi: 10.1007/s00264-010-1014-8
Main files (1)
Article (Published version)
accessLevelPublic
Identifiers
Journal ISSN0341-2695
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742downloads

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