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J Bone Jt Infect. 2019 May 21;4(3):120-125. doi: 10.7150/jbji.32975. eCollection 2019.

The Journey of Cultures Taken During Revision Joint Arthroplasty: Preanalytical Phase.

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Rothman Institute at Thomas Jefferson University, Philadelphia, PA 19017.


Background: Microbiological culture has been considered the standard for pathogen identification for decades. However, culture is a laborious, time consuming, imperfect and outdated process. This study aims to inform the orthopedic community of the steps and timing of routine culture processing. Methods: We prospectively tracked 103 cultures from 33 revision hip and knee arthroplasty patients between September 2017-February 2018. Times were recorded at intraoperative collection; time of pick up from OR, transportation time; arrival at the laboratory; culture processing and plating time; and time to final result reporting. Results: Of the 103 cultures, 45.6% were processed and incubated in less than two hours, and 54.4% greater than or equal to two hours. The mean time spent in the OR, during transport, and within the laboratory prior to incubation was 0:53, 0:06 and 1:12. The range of time that samples remained at each stage varied considerably in the OR (0:03-3:33), in transit(0:04-0:16), and in the lab prior to incubation(0:26-3:01). The proportion of the total time to incubation attributed to idle time samples spent in the OR after initial sampling was 40.0%. In contrast, transport to the laboratory represented 5.1% of the total time. Idle time in the laboratory represented the greatest share at 54.9%. Conclusion: There is significant variability in the time to transport, process and incubate culture samples. Almost half of the specimens were processed outside the 2-hour recommended window. Surgeons should be aware of idle time during processing and seek to optimize their institutional pathways to maximize culture yield.


culture processing; hip; knee; revision arthroplasty; timing

Conflict of interest statement

Competing Interests: The following authors Kier Blevins and Karan Goswami have declared that no competing interest exists. The following Author Javad Parvizi's competing interests include:Board Membership: 3M; Eastern Orthopaedic Association; Muller Foundation; United Healthcare.Editorial Board: Journal of Bone and Joint Surgery.Royalties: Corentec.Publishing Royalties: DataTrace; Elsevier; Jaypee Publishers; SLACK Incorporated; Wolters Kluwer.Stock Ownership: Parvizi Surgical Innovations; Hip Innovation Technology; Cross Current Business Intelligence; Alphaeon; Joint Purification Systems; Ceribell; MedAp; Physician Recommended Nutriceuticals; PRN-Veterinary; MDValuate; Intellijoint; MicrogenDx; Corentec.Paid Consulting: Zimmer Biomet; Stryker; TissueGene; CeramTec; Corenetc; Ethicon; Tenor; KCI; Heraeus.

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