A comprehensive review of the diagnosis and management of prosthetic joint infections in the absence of positive cultures (original) (raw)
Related papers
Epidemiology and new developments in the diagnosis of prosthetic joint infection
The International Journal of Artificial Organs, 2012
Although prosthetic joint infection (PJI) is a rare event after arthroplasty, it represents a significant complication that is associated with high morbidity, need for complex treatment, and substantial healthcare costs. An accurate and rapid diagnosis of PJI is crucial for treatment success. Current diagnostic methods in PJI are insufficient with 10–30% false-negative cultures. Consequently, there is a need for research and development into new methods aimed at improving diagnostic accuracy and speed of detection. In this article, we review available conventional diagnostic methods for the diagnosis of PJI (laboratory markers, histopathology, synovial fluid and periprosthetic tissue cultures), new diagnostic methods (sonication of implants, specific and multiplex PCR, mass spectrometry) and innovative techniques under development (new laboratory markers, microcalorimetry, electrical method, reverse transcription [RT]-PCR, fluorescence in situ hybridization [FISH], biofilm microscop...
The diagnosis and management of prosthetic joint infections
Journal of Antimicrobial Chemotherapy, 2010
A host of technical and operative improvements have seen the rates of infection associated with joint replacement reach historic lows. However, the increasing number of operations being performed means that the absolute number of such infections remains significant. Diagnosis may be challenging and delaying appropriate treatment can lead to reduced joint function and the need for more complex, perhaps multiple, procedures. Individual centres tend to see small numbers of such cases, and in the absence of large clinical trials management varies. Early diagnosis, selection of an appropriate surgical strategy, accurate identification of the responsible microorganisms and construction of an appropriate antibiotic regimen are essential elements of any management strategy. Such packages of care are best delivered by a multidisciplinary team composed of orthopaedic and plastic surgeons, microbiologists, infectious disease physicians, specialist nurses, physiotherapists and occupational therapists. Each treatment plan must be developed in consultation with the patient, taking into account their aims and realistic goals. This review provides an overview of current understanding regarding diagnosis and treatment of prosthetic joint infections and suggests a treatment algorithm.
Laboratory Diagnosis of Prosthetic Joint Infection, Part I
Clinical Microbiology Newsletter, 2011
When evaluating a patient with prosthetic joint dysfunction, clinicians have to determine first if the cause of the dysfunction is septic or aseptic. The diagnosis of PJI can be made clinically in
European Journal of Clinical Microbiology & Infectious Diseases, 2022
Sensitive and specific tests for the diagnosis of prosthetic joint infection (PJI) are lacking. The aim of this study was to report clinical and microbiological findings of consecutive patients diagnosed with PJI at the University Hospital of Perugia, Perugia, Italy, and to validate these diagnoses utilizing the European Bone and Joint Infection Society (EBJIS) three-level diagnostic approach from 2021. Patients with a PJI diagnosis were included in this study and examined retrospectively. Overall, 133 patients were diagnosed with PJI: mean age 72 years, 54.9% female, and 55.6% with more than one comorbidity. The most frequent involved joints were hip 47% and knee 42%. Aetiology was identified in 88/133 (66.2%): staphylococci resulted the most frequent microorganisms and over 80% (45/54) resulted rifampin susceptible. Applying the EBJIS approach, PJI diagnosis resulted: confirmed in 101 (75.9%), likely in 25 (18.8%), and unlikely in 7 (5.3%). Likely PJIs aetiology was Staphylococcus...
Journal of Clinical Microbiology and Infectious Diseases
Pathogen identification in prosthetic joint infection is necessary to achieve optimal patient management. The specimens for diagnosis of prosthetic joint infection could be the synovial fluid, the tissue obtained intraoperatively, and the biofilm from the implanted prosthesis. Because of the low sensitivity of the conventional specimen culture method, the preanalytic treatment of the specimen was widely studied to increase the yield of detection. This review aimed to describe the current specimen processing methods used in the clinical setting to increase the pathogen detection rate. A blood culture bottle, tissue homogenization, and explanted prosthesis sonication were the most studied methods with a good result. Molecular methods were also developed to reduce the time of pathogen detection. MALDI-TOF was studied to reduce identification time after a positive culture. Other molecular methods such as polymerase chain reaction and next-generation sequencing were studied to omit the c...
European Journal of Nuclear Medicine and Molecular Imaging
Background For the diagnosis of prosthetic joint infection, real evidence-based guidelines to aid clinicians in choosing the most accurate diagnostic strategy are lacking. Aim and Methods To address this need, we performed a multidisciplinary systematic review of relevant nuclear medicine, radiological, orthopaedic, infectious, and microbiological literature to define the diagnostic accuracy of each diagnostic technique and to address and provide evidence-based answers on uniform statements for each topic that was found to be important to develop a commonly agreed upon diagnostic flowchart. Results and Conclusion The approach used to prepare this set of multidisciplinary guidelines was to define statements of interest and follow the procedure indicated by the Oxford Centre for Evidence-based Medicine (OCEBM).
Diagnosis and management of prosthetic joint infection
BMJ, 2009
Joint replacement is safe, cost effective, 1 and widely undertaken. Most prosthetic joint replacements are hips and knees; more than 130 000 people underwent such procedures in England and Wales in the 12 months from April 2006. w1 Subsequent prosthetic joint infection is uncommon-the incidence varies between 0.6% and 2% per joint per year. 2-5 However, this complication is associated with substantial morbidity and economic cost ($30 000 (£20 500; €22 800) to $50 000 per patient). 3 4 6 w2 The diagnosis of prosthetic joint infection is difficult, w2 because symptoms, signs, and investigations may all be non-specific. 7 w3 Defining diagnostic criteria and optimum management is complicated by patient heterogeneity and the small numbers in many published studies. w4 However, prompt recognition and diagnosis of prosthetic joint infection facilitates timely intervention to salvage infected joints, preserve joint function, prevent morbidity, and reduce costs.