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      Should all patients with a culture-negative periprosthetic joint infection be treated with antibiotics? : a multicentre observational study

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          Abstract

          Aims

          The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld.

          Methods

          A multicentre observational study was undertaken: 1,553 acute and 1,556 chronic PJIs, diagnosed between 2013 and 2018, were retrospectively analyzed. Culture-negative PJIs were diagnosed according to the Muskuloskeletal Infection Society (MSIS), International Consensus Meeting (ICM), and European Bone and Joint Society (EBJIS) definitions. The primary outcome was recurrent infection, and the secondary outcome was removal of the prosthetic components for any indication, both during a follow-up period of two years.

          Results

          None of the acute PJIs and 70 of the chronic PJIs (4.7%) were culture-negative; a total of 36 culture-negative PJIs (51%) were treated with antibiotics, particularly those with histological signs of infection. After two years of follow-up, no recurrent infections occurred in patients in whom antibiotics were withheld. The requirement for removal of the components for any indication during follow-up was not significantly different in those who received antibiotics compared with those in whom antibiotics were withheld (7.1% vs 2.9%; p = 0.431).

          Conclusion

          When adequate methods of culture are used, the incidence of culture-negative PJIs is low. In patients with culture-negative PJI, antibiotic treatment can probably be withheld if there are no histological signs of infection. In all other patients, diagnostic efforts should be made to identify the causative microorganism by means of serology or molecular techniques. Cite this article: Bone Joint J 2022;104-B(1):183–188.

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          Most cited references14

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          The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria

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            Definition of periprosthetic joint infection.

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              The EBJIS definition of periprosthetic joint infection

              Aims The diagnosis of periprosthetic joint infection (PJI) can be difficult. All current diagnostic tests have problems with accuracy and interpretation of results. Many new tests have been proposed, but there is no consensus on the place of many of these in the diagnostic pathway. Previous attempts to develop a definition of PJI have not been universally accepted and there remains no reference standard definition. Methods This paper reports the outcome of a project developed by the European Bone and Joint Infection Society (EBJIS), and supported by the Musculoskeletal Infection Society (MSIS) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Implant-Associated Infections (ESGIAI). It comprised a comprehensive review of the literature, open discussion with Society members and conference delegates, and an expert panel assessment of the results to produce the final guidance. Results This process evolved a three-level approach to the diagnostic continuum, resulting in a definition set and guidance, which has been fully endorsed by EBJIS, MSIS, and ESGIAI. Conclusion The definition presents a novel three-level approach to diagnosis, based on the most robust evidence, which will be useful to clinicians in daily practice. Cite this article: Bone Joint J 2021;103-B(1):18–25.
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                Author and article information

                Journal
                The Bone & Joint Journal
                The Bone & Joint Journal
                British Editorial Society of Bone & Joint Surgery
                2049-4394
                2049-4408
                January 01 2022
                January 01 2022
                : 104-B
                : 1
                : 183-188
                Affiliations
                [1 ] Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
                [2 ] Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain
                [3 ] Department of Infectious and Tropical Diseases, Hospital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
                [4 ] Infectious Diseases Unit, University Hospital IRCCS Policlinico Sant'Orsola, Bologna, Italy
                [5 ] Institute of Medical Laboratory Diagnostics, HELIOS University Clinic Wuppertal, Witten/Herdecke University, Witten, Germany
                [6 ] H-HiP, Department of Orthopaedic Surgery, Regional Hospital Horsens, Horsens, Denmark
                [7 ] Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
                [8 ] Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Barcelona, Spain
                [9 ] Department of Infectious Diseases, Centro Hospitalar e Universitário do Porto. GRIP, Porto Bone & Joint infection group, Porto, Portugal
                [10 ] Department of Orthopaedics and Traumatology, Septic surgical Unit, University Hospital of Lausanne, CHUV, University of Lausanne, Lausanne, Switzerland
                [11 ] Department of Microbiology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
                [12 ] Department of Orthopaedics, Ganga Hospital, Coimbatore, India
                Article
                10.1302/0301-620X.104B1.BJJ-2021-0693.R2
                34969292
                b11c35a7-e1dd-4eb2-9b67-f7c3c6b914eb
                © 2022

                https://online.boneandjoint.org.uk/TDM

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