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Clin Infect Dis. 2007 Nov 1;45(9):1113-9. Epub 2007 Sep 26.

Culture-negative prosthetic joint infection.

Author information

1
Section of Orthopedic infectious Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA. Berbari.elie@mayo.edu

Abstract

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.

PMID:
17918072
DOI:
10.1086/522184
[Indexed for MEDLINE]

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