Clinical Orthopaedics and Related Research®

, Volume 468, Issue 8, pp 2039–2045 | Cite as

Prior Use of Antimicrobial Therapy is a Risk Factor for Culture-negative Prosthetic Joint Infection

  • Davud Malekzadeh
  • Douglas R. Osmon
  • Brian D. Lahr
  • Arlen D. Hanssen
  • Elie F. Berbari
Symposium: Papers Presented at the 2009 Meeting of the Musculoskeletal Infection Society
First Online:

Abstract

Background

Clinical characteristics and control of the infection of patients with culture-negative (CN) prosthetic joint infection (PJI) have not been well assessed. Prior use of antimicrobial therapy has been speculated but not proven as a risk factor for CNPJI.

Questions/purposes

We therefore determined whether prior use of antimicrobial therapy, prior PJI, and postoperative wound healing complications were associated with CN PJI.

Methods

We performed a retrospective case-control study of 135 patients with CN PJI treated between January 1, 1985, and December 31, 2000 matched with 135 patients with culture-positive (CP) PJIs (control patients) during the study period. The time to failure of therapy compared between cases and control patients using a Kaplan-Meier analysis.

Results

The use of prior antimicrobial therapy and postoperative wound drainage after index arthroplasty were associated with increased odds of PJI being culture-negative (odds ratio, 4.7; 95% CI, 2.8–8.1 and odds ratio, 3.5; 95% CI, 1.5–8.1, respectively). The percent (± SE) cumulative incidence free of treatment failure at 2 years followup was similar for CN and CP PJI: 75% (± 4%) and 79% (± 4%), respectively.

Conclusions

Prior antimicrobial therapy and postoperative wound drainage were associated with an increased risk of negative cultures among patients with PJI. Physicians should critically evaluate the need for antimicrobial therapy before establishing a microbiologic diagnosis of PJI in patients with suspected PJI.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Keywords

Antimicrobial Therapy Sinus Tract Prosthetic Joint Infection Resection Arthroplasty Periprosthetic Tissue 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Notes

Acknowledgments

We thank other members of the Mayo PJI study group: Robin Patel, James Steckelberg, Jeanette Eckel-Passow, Irene Sia, and Mary Duffy for their help in the design, data collection, analysis, and review of the final manuscript.

References

  1. 1.
    Ahlberg A, Carlsson AS, Lindberg L. Hematogenous infection in total joint replacement. Clin Orthop Relat Res. 1978;137:69–75.PubMedGoogle Scholar
  2. 2.
    Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, Osmon DR. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis. 1998;27:1247–1254.CrossRefPubMedGoogle Scholar
  3. 3.
    Berbari EF, Marculescu C, Sia I, Lahr BD, Hanssen AD, Steckelberg JM, Gullerud R, Osmon DR. Culture-negative prosthetic joint infection. Clin Infect Dis. 2007;45:1113–1119.CrossRefPubMedGoogle Scholar
  4. 4.
    Berbari EF, Osmon DR, Duffy MC, Harmssen RN, Mandrekar JN, Hanssen AD, Steckelberg JM. Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes. Clin Infect Dis. 2006;42:216–223.CrossRefPubMedGoogle Scholar
  5. 5.
    Cockroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31–41.CrossRefGoogle Scholar
  6. 6.
    Kurtz S, Lau E, Halpern M, Ong K. Trend shows growing orthopedic surgery case load. Will surgeons be able to keep up? Mater Manag Health Care. 2006;15:61–62.PubMedGoogle Scholar
  7. 7.
    Lavernia CJ, Sierra RJ, Hernandez RA. The cost of teaching total knee arthroplasty surgery to orthopaedic surgery residents. Clin Orthop Relat Res. 2000;380:99–107.CrossRefPubMedGoogle Scholar
  8. 8.
    Marculescu CE, Berbari EF, Hanssen AD, Steckelberg JM, Harmsen SW, Mandrekar JN, Osmon DR. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis. 2006;42:471–478.CrossRefPubMedGoogle Scholar
  9. 9.
    Powers KA, Terpenning MS, Voice RA, Kauffman CA. Prosthetic joint infections in the elderly. Am J Med. 1990;88:9N–13N.PubMedGoogle Scholar
  10. 10.
    Sia IG, Berbari EF, Karchmer AW. Prosthetic joint infections. Infect Dis Clin North Am. 2005;19:885–914.CrossRefPubMedGoogle Scholar
  11. 11.
    Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357:654–663.CrossRefPubMedGoogle Scholar
  12. 12.
    Zimmerli W, Ochsner PE. Management of infection associated with prosthetic joint infection. Infection. 2003;31:99–108.CrossRefPubMedGoogle Scholar
  13. 13.
    Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645–1654.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Davud Malekzadeh
    • 1
  • Douglas R. Osmon
    • 2
  • Brian D. Lahr
    • 3
  • Arlen D. Hanssen
    • 4
  • Elie F. Berbari
    • 2
  1. 1.Paracelsus Medical PrivatuniversitySalzburgAustria
  2. 2.Section of Orthopedic Infectious DiseasesMayo Clinic College of MedicineRochesterUSA
  3. 3.Division of Biomedical Statistics and InformaticsMayo Clinic RochesterRochesterUSA
  4. 4.Department of Orthopedic SurgeryMayo ClinicRochesterUSA

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