Culture-Negative Prosthetic Joint Infection
| Autor: | Camelia E. Marculescu, Rachel E. Gullerud, James M. Steckelberg, Douglas R. Osmon, Brian D. Lahr, Irene Sia, Arlen D. Hanssen, Elie F. Berbari |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Adult
Male Microbiology (medical) medicine.medical_specialty Prosthesis-Related Infections Arthroplasty Replacement Hip Joint Prosthesis medicine.medical_treatment Periprosthetic Arthritis Prosthesis Cohort Studies Anti-Infective Agents Risk Factors medicine Humans Treatment Failure Arthroplasty Replacement Knee Aged Retrospective Studies Aged 80 and over business.industry Retrospective cohort study Middle Aged medicine.disease Arthroplasty Confidence interval Surgery Infectious Diseases Cohort Female business Cohort study |
| Zdroj: | Clinical Infectious Diseases. 45:1113-1119 |
| ISSN: | 1537-6591 1058-4838 |
| Popis: | Background. Culture-negative (CN) prosthetic joint infection (PJI) has not been well studied. We performed a retrospective cohort study to define the demographic characteristics and determine the outcome of patients with CN PJI. Methods. All cases of CN total hip arthroplasty and total knee arthroplasty infections (using a strict case definition) treated at our institution from January 1990 through December 1999 were analyzed. Kaplan-Meier survival methods were used to determine the cumulative probability of success. Results. Of 897 episodes of PJI during the study period, 60 (7%) occurred in patients for whom this was the initial episode of CN PJI. The median age of the cohort was 69 years (range, 36‐87 years). Patients had received a prior course of antimicrobial therapy in 32 (53%) of 60 episodes. Of the 60 episodes, 34 (57%), 12 (20%), and 8 (13%) were treated with 2-stage exchange, debridement and retention, and permanent resection arthroplasty, respectively. The median duration of parenteral antimicrobial therapy was 28 days (range, 0‐88 days). Forty-nine (82%) of 60 episodes were treated with a cephalosporin. The 5-year estimate of survival free of treatment failure was 94% (95% confidence interval, 85%‐100%) for patients treated with 2-stage exchange and 71% (95% confidence interval, 44%‐100%) for patients treated with debridement and retention. Conclusions. CN PJI occurs infrequently at our institution. Prior use of antimicrobial therapy is common among patients with CN PJI. CN PJI treated at our institution is associated with a rate of favorable outcome that is comparable to that associated with PJI due to known bacterial pathogens. Prosthetic joint infection ( PJI) involving a total hip athroplasty or total knee arthroplasty can occur in up to 5% of patients undergoing total joint replacement. Staphylococcus aureus and coagulase-negative Staphylococcus species account for close to 65% of PJIs [1‐9]. We have observed a significant number of patients with PJI for whom aerobic and anaerobic cultures of periprosthetic tissue samples did not reveal the growth of any microorganisms. These patients received a diagnosis of PJI on the basis of the presence of periprosthetic purulence, acute pathology revealed by histopathologic examination of periprosthetic tissue samples, or a sinus tract communicating with the prosthesis. Although the outcome of microbiologically confirmed PJI |
| Databáze: | OpenAIRE |
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