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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 AdultAgedAged, 80 and overArthroplasty, Replacement, Hip/adverse effectsArthroplasty, Replacement, Knee/adverse effectsBacteriological TechniquesC-Reactive Protein/analysisFalse Negative ReactionsFalse Positive ReactionsFemaleHip Joint/microbiology/surgeryHumansIntraoperative PeriodKnee Joint/microbiology/surgeryMaleMiddle AgedPredictive Value of TestsProsthesis-Related Infections/blood/diagnosis/microbiologyRecurrenceReoperationRetrospective StudiesSuction/methods
PMID: 20419507
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Research groups Chirurgie orthopédique et traumatologique (98)
Glycopeptide résistance (28)
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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

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Deposited on : 2013-01-02

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