Antibiotic therapy alone does not have a high success rate in cases of unexpected positive cultures in intraoperative samples from hip and knee prosthesis revision

Bernd Fink,Michael Schlumberger

doi:10.1186/s12891-020-03799-w

Abstract

BackgroundUnexpectedly positive bacterial cultures during prosthesis revision surgery still occur on occasion despite good preoperative diagnostics. In such cases a six-week antibiotic therapy without further surgical intervention is recommended. The aim of this study was to find out how successful this procedure is.MethodsIn a study of 508 patients, who required revision surgery of total hip (THA, n = 231) or knee arthroplasties (TKA, n = 277) because of component loosening, biopsy was carried out before their surgery. The collected tissue samples (5) from the biopsy and the revision surgery procedure itself were analyzed according the criteria of the International Consensus Meeting (ICM). Tests revealed 11 patients (7 THA, 4 TKA) with unexpectedly positive bacterial cultures from tissue samples obtained during the revision surgery due to false negative preoperative diagnostic results. These 11 patients were treated with 6 weeks antibiotic therapy and examined with a follow-up of at least 2 years (42.2 ± 16.5 months).ResultsFive patients (2 TKA, 3 THA) became reinfected, resulting in a success rate of 54.5%.ConclusionAntibiotic therapy alone of an unexpected positive intraoperative bacterial culture in prosthesis revision surgery seems to be less successful than previously assumed.

Highlights

Positive bacterial cultures during prosthesis revision surgery still occur on occasion despite good preoperative diagnostics
Despite all efforts of preoperative diagnostic procedures prior to prosthesis revision surgery, negative preoperative results can occasionally be followed by positive bacterial cultures of several tissue samples obtained during the revision surgery
It cannot be ruled out that some of the patients in those early studies were wrongly classified as Periprosthetic joint infection (PJI) due to false positive intraoperative diagnostics and a falsely high rate of success was determined for the sole antibiotic therapy of “type 1 infections”

Summary

Introduction

Positive bacterial cultures during prosthesis revision surgery still occur on occasion despite good preoperative diagnostics. In such cases a six-week antibiotic therapy without further surgical intervention is recommended. The preoperative results can be described as false negatives and, by definition, a periprosthetic infection can be declared This situation is called “positive intraoperative culture” or “type 1 infection” in the most commonly used. Mostly older studies, the incidence of “type 1 infections” in prosthesis revisions is reported to be between 1.6 and 29.2% depending on the quality of the preoperative infection diagnostic procedures [9,10,11,12,13]. It cannot be ruled out that some of the patients in those early studies were wrongly classified as PJI due to false positive intraoperative diagnostics and a falsely high rate of success was determined for the sole antibiotic therapy of “type 1 infections”

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