CLINICAL CHARACTERS OF CULTURE-NEGATIVE PROSTHETIC JOINT INFECTION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIHeng , YANGRui , GENGLei , YANGYunjian , ZHANGZhendong ,  CHENJiying

Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;

Corresponding author：

CHENJiying, Email: chenjiying_301@163.com

Keywords：

Prosthetic joint infection; Bacterial culture; C reaction protein; Erythrocyte sedimentation rate

DOI：

10.7507/1002-1892.20140007

Video：

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Objective To explore the clinical characters and histopathologic differences between patients with culture-positive and culture-negative prosthetic joint infection (PJI). Methods Between January 2012 and July 2013, 66 PJI patients in accord with diagnostic criteria were enrolled. According to the results of preoperative aspiration and intraoperative cultures, the patients were divided into culture-negative group (CN group, n=21) and culture-positive group (CP group, n=45). There was no significant difference in gender, age, height, weight, and body mass index between 2 groups (P>0.05). Preoperative C reactive protein (CRP), erythrocyte sedimentation rate (ESR), and prosthesis survival time were compared between 2 groups. Intraoperative frozen sections and paraffin sections were both performed to identify infections, and histological typing was performed according to Morawietz's methods. Results The preoperative CRP was (1.29±1.84) mg/ dL in CN group and (5.08±9.57) mg/dL in CP group, showing significant difference (t=2.094, P=0.038). The preoperative ESR was (22.86±28.42) mm/1 h in CN group and (36.74±31.26) mm/1 h in CP group, showing significant difference (t=7.761, P=0.000). The median survival time of prosthesis was 72 months (range, 8-504 months) in CN group and 25 months (range, 15 days-300 months) in CP group, showing significant difference (U=2.231, P=0.026). Morawietz's histological typing results showed that 2 cases were rated as type I, 7 cases as type II, and 12 cases as type III in CN group; 6 cases were rated as type I, 25 cases as type II, 13 cases as type III, and 1 case as type IV in CP group. The positive culture rate was 68.18% (45/66), and pathogenic bacteria was dominated by Staphylococcus, accounting for 68.89%. Conclusion The patients with culture-negative PJI have slow onset and mild inflammatory response, so comprehensive diagnosis should be made based on pathological detection, laboratory examination, and intraoperative cultures.

Citation： LIHeng, YANGRui, GENGLei, YANGYunjian, ZHANGZhendong, CHENJiying. CLINICAL CHARACTERS OF CULTURE-NEGATIVE PROSTHETIC JOINT INFECTION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 30-33. doi: 10.7507/1002-1892.20140007 Copy

1.	Osmon DR,Berbari EF,Berendt AR,et al.Diagnosis and management of prosthetic joint infection:clinical practice guidelines by the infectious diseases society of America.Clin Infect Dis,2013,56(1):e1-e25.
2.	Sabry FY,Buller L,Ahmed S,et al.Preoperative prediction of failure following two-stage revision for knee prosthetic joint infections.J Arthroplasty,2013.[Epub ahead of print].
3.	Huang R,Hu CC,Adeli B,et al.Culture-negative periprosthetic joint infection does not preclude infection control.Clin Orthop Relat Res,2012,470(10):2717-2723.
4.	Choi HR,Kwon YM,Freiberg AA,et al.Periprosthetic joint infection with negative culture results:clinical characteristics and treatment outcome.J Arthroplasty,2013,28(6):899-903.
5.	Hindle P,Davidson E,Biant LC.Septic arthritis of the knee:the use and effect of antibiotics prior to diagnostic aspiration.Ann R Coll Surg Engl,2012,94(5):351-355.
6.	Zimmerli W,Trampuz A,Ochsner PE.Prosthetic-joint infections.N Engl J Med,2004,351(16):1645-1654.
7.	Gunthard H,Hany A,Turina M,et al.Propionibacterium acnes as a cause of aggressive aortic valve endocard I and impor-tance of tissue grinding:case report and review.J Clin Microbiol,1994,32(12):3043-3045.
8.	Bori G,Soriano A,García S,et al.Neutrophils in frozen section and type of microorganism isolated at the time of resection arthroplasty for the treatment of infection.Arch Orthop Trauma Surg,2009,129(5):591-595.
9.	Morawietz L,Classen RA,Schröder JH,et al.Proposal for a histopathological consensus classification of the periprosthetic interface membrane.J Clin Pathol,2006,59(6):591-597.
10.	Parvizi J,Suh DH,Jafari SM,et al.Aseptic loosening of total hip arthroplasty:infection always should be ruled out.Clin Orthop Relat Res,2011,469(5):1401-1405.
11.	Bereza PL,Ekiel A,Auguściak-Duma A,et al.Identification of silent prosthetic joint infection:preliminary report of a prospective controlled study.Int Orthop,2013,37(10):2037-2043.
12.	Müller M,Morawietz L,Hasart O,et al.Diagnosis of periprosthetic infection following total hip arthroplasty-evaluation of the diagnostic values of pre-and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection.J Orthop Surg Res,2008,3:31.
13.	Mortazavi SM,Vegari D,Ho A,et al.Two-stage exchange arthroplasty for infected total knee arthroplasty:predictors of failure.Clin Orthop Relat Res,2011,469(11):3049-3054.
14.	Cazanave C,Greenwood-Quaintance K,Hanssen AD,et al.Rapid molecular microbiologic diagnosis of prosthetic joint infection.J Clin Microbiol,2013,51(7):2280-2287.
15.	Gomez E,Cazanave C,Cunningham SA,et al.Prosthetic joint infection diagnosis using broad-range PCR of biofilms dislodged from knee and hip arthroplasty surfaces using sonication.J Clin Microbiol,2012,50(11):3501-3508.
16.	Jacovides CL,Kreft R,Adeli B,et al.Successful identification of pathogens by polymerase chain reaction (PCR)-based electron spray ionization time-of-flight mass spectrometry (ESI-TOF-MS) in culture-negative periprosthetic joint infection.J Bone Joint Surg (Am),2012,94(24):2247-2254.
17.	Trampuz A,Steckelberg JM,Osmon DR,et al.Advances in the laboratory diagnosis of prosthetic joint infection.Reviews in Medical Microbiology,2002,14(1):1-14.
18.	Lee SC,Jung KA,Yoon JY,et al.Analysis of synovial fluid in culture-negative samples of suspicious periprosthetic infections.Orthopedics,2010,33(10):725.
19.	Bejon P,Berendt A,Atkins BL,et al.Two-stage revision for prosthetic joint infection:predictors of outcome and the role of reimplantation microbiology.J Antimicrob Chemother,2010,65(3):569-575.
20.	Berbari EF,Marculescu C,Sia I,et al.Culture-negative prosthetic joint infection.Clin Infect Dis,2007,45(9):1113-1119.
21.	Portillo ME,Salvadó M,Alier A,et al.Prosthesis failure within 2 years of implantation is highly predictive of infection.Clin Orthop Relat Res,2013,471(11):3672-3678.
22.	Peel TN,Cheng AC,Buising KL,et al.Microbiological aetiology,epidemiology,and clinical profile of prosthetic joint infections:are current antibiotic prophylaxis guidelines effective? Antimicrob Agents Chemother,2012,56(5):2386-2391.

1. Osmon DR,Berbari EF,Berendt AR,et al.Diagnosis and management of prosthetic joint infection:clinical practice guidelines by the infectious diseases society of America.Clin Infect Dis,2013,56(1):e1-e25.
2. Sabry FY,Buller L,Ahmed S,et al.Preoperative prediction of failure following two-stage revision for knee prosthetic joint infections.J Arthroplasty,2013.[Epub ahead of print].
3. Huang R,Hu CC,Adeli B,et al.Culture-negative periprosthetic joint infection does not preclude infection control.Clin Orthop Relat Res,2012,470(10):2717-2723.
4. Choi HR,Kwon YM,Freiberg AA,et al.Periprosthetic joint infection with negative culture results:clinical characteristics and treatment outcome.J Arthroplasty,2013,28(6):899-903.
5. Hindle P,Davidson E,Biant LC.Septic arthritis of the knee:the use and effect of antibiotics prior to diagnostic aspiration.Ann R Coll Surg Engl,2012,94(5):351-355.
6. Zimmerli W,Trampuz A,Ochsner PE.Prosthetic-joint infections.N Engl J Med,2004,351(16):1645-1654.
7. Gunthard H,Hany A,Turina M,et al.Propionibacterium acnes as a cause of aggressive aortic valve endocard I and impor-tance of tissue grinding:case report and review.J Clin Microbiol,1994,32(12):3043-3045.
8. Bori G,Soriano A,García S,et al.Neutrophils in frozen section and type of microorganism isolated at the time of resection arthroplasty for the treatment of infection.Arch Orthop Trauma Surg,2009,129(5):591-595.
9. Morawietz L,Classen RA,Schröder JH,et al.Proposal for a histopathological consensus classification of the periprosthetic interface membrane.J Clin Pathol,2006,59(6):591-597.
10. Parvizi J,Suh DH,Jafari SM,et al.Aseptic loosening of total hip arthroplasty:infection always should be ruled out.Clin Orthop Relat Res,2011,469(5):1401-1405.
11. Bereza PL,Ekiel A,Auguściak-Duma A,et al.Identification of silent prosthetic joint infection:preliminary report of a prospective controlled study.Int Orthop,2013,37(10):2037-2043.
12. Müller M,Morawietz L,Hasart O,et al.Diagnosis of periprosthetic infection following total hip arthroplasty-evaluation of the diagnostic values of pre-and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection.J Orthop Surg Res,2008,3:31.
13. Mortazavi SM,Vegari D,Ho A,et al.Two-stage exchange arthroplasty for infected total knee arthroplasty:predictors of failure.Clin Orthop Relat Res,2011,469(11):3049-3054.
14. Cazanave C,Greenwood-Quaintance K,Hanssen AD,et al.Rapid molecular microbiologic diagnosis of prosthetic joint infection.J Clin Microbiol,2013,51(7):2280-2287.
15. Gomez E,Cazanave C,Cunningham SA,et al.Prosthetic joint infection diagnosis using broad-range PCR of biofilms dislodged from knee and hip arthroplasty surfaces using sonication.J Clin Microbiol,2012,50(11):3501-3508.
16. Jacovides CL,Kreft R,Adeli B,et al.Successful identification of pathogens by polymerase chain reaction (PCR)-based electron spray ionization time-of-flight mass spectrometry (ESI-TOF-MS) in culture-negative periprosthetic joint infection.J Bone Joint Surg (Am),2012,94(24):2247-2254.
17. Trampuz A,Steckelberg JM,Osmon DR,et al.Advances in the laboratory diagnosis of prosthetic joint infection.Reviews in Medical Microbiology,2002,14(1):1-14.
18. Lee SC,Jung KA,Yoon JY,et al.Analysis of synovial fluid in culture-negative samples of suspicious periprosthetic infections.Orthopedics,2010,33(10):725.
19. Bejon P,Berendt A,Atkins BL,et al.Two-stage revision for prosthetic joint infection:predictors of outcome and the role of reimplantation microbiology.J Antimicrob Chemother,2010,65(3):569-575.
20. Berbari EF,Marculescu C,Sia I,et al.Culture-negative prosthetic joint infection.Clin Infect Dis,2007,45(9):1113-1119.
21. Portillo ME,Salvadó M,Alier A,et al.Prosthesis failure within 2 years of implantation is highly predictive of infection.Clin Orthop Relat Res,2013,471(11):3672-3678.
22. Peel TN,Cheng AC,Buising KL,et al.Microbiological aetiology,epidemiology,and clinical profile of prosthetic joint infections:are current antibiotic prophylaxis guidelines effective? Antimicrob Agents Chemother,2012,56(5):2386-2391.

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CLINICAL CHARACTERS OF CULTURE-NEGATIVE PROSTHETIC JOINT INFECTION

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