Antibiotic therapy alone does not have a high success rate in cases of unexpected positive cultures in intraoperative sa
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(2020) 21:786
RESEARCH ARTICLE
Open Access
Antibiotic therapy alone does not have a high success rate in cases of unexpected positive cultures in intraoperative samples from hip and knee prosthesis revision Bernd Fink1,2*
and Michael Schlumberger1
Abstract Background: Unexpectedly positive bacterial cultures during prosthesis revision surgery still occur on occasion despite good preoperative diagnostics. In such cases a six-week antibiotic therapy without further surgical intervention is recommended. The aim of this study was to find out how successful this procedure is. Methods: In a study of 508 patients, who required revision surgery of total hip (THA, n = 231) or knee arthroplasties (TKA, n = 277) because of component loosening, biopsy was carried out before their surgery. The collected tissue samples (5) from the biopsy and the revision surgery procedure itself were analyzed according the criteria of the International Consensus Meeting (ICM). Tests revealed 11 patients (7 THA, 4 TKA) with unexpectedly positive bacterial cultures from tissue samples obtained during the revision surgery due to false negative preoperative diagnostic results. These 11 patients were treated with 6 weeks antibiotic therapy and examined with a follow-up of at least 2 years (42.2 ± 16.5 months). Results: Five patients (2 TKA, 3 THA) became reinfected, resulting in a success rate of 54.5%. Conclusion: Antibiotic therapy alone of an unexpected positive intraoperative bacterial culture in prosthesis revision surgery seems to be less successful than previously assumed. Keywords: Periprosthetic joint infection, Positive culture intraoperative, Antibiotic treatment
Background Periprosthetic joint infection (PJI) is a severe complication of joint replacement surgery, with an incidence ranging between 1 and 2% after primary and between 2 and 6% after revision arthroplasty [1–3]. However, some studies report PJI to be the most common cause for revision in the first 5 years following primary arthroplasty [1, 4–6]. The accuracy of the preoperative diagnosis of * Correspondence: [email protected] 1 Department for Joint Replacement, Rheumatoid and General Orthopaedics, Orthopaedic Clinic Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany 2 Orthopaedic Department, University Hospital Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20251, Germany
possible infection becomes especially important in cases of loosened and painful joint endoprostheses because the presence of a PJI would result in significant changes to the subsequent therapeutic procedures [7, 8]. However, despite all efforts of preoperative diagnostic procedures prior to prosthesis revision surgery, negative preoperative results can occasionally be followed by positive bacterial cultures of several tissue samples obtained during the revision surgery. Thus, the preoperative results can then be described as false negatives and, by definition, a periprosthetic infection can be declared. This situation is called “positive intraoperative culture” or “type 1 infe
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