Microbiological diagnosis of periprosthetic joint infections

Abstract

Prosthetic joint infection is a rare but serious complication after arthroplasty, leading to prolonged hospitalization and repeated surgical intervention. In this article, successful strategies for the rapid and accurate microbiological diagnosis of infection are reviewed. In the case of clinical suspicion of a prosthetic joint infection, at least a comprehensive clinical review of the patient's postoperative history, a physical examination, routine blood tests including white cell count, erythrocyte sedimentation rate, and C-reactive protein, and further investigation of the synovial-fluid leukocyte count and microbial culture are needed. Depending of the clinical signs of infection additional blood culture samples should be taken. The gold standard to confirm infection is a surgical procedure with at least 5-6 biopsies from suspected areas for both microbial culture and histopathological examination. Culture results may be negative because of previous antimicrobial therapy, a low number of culturable organisms in biofilm formations, inappropriate culture medium, and prolonged transport time. In any of these conditions, diagnosis with highly sensitive diagnostic techniques such as polymerase chain reaction should be considered for the identification of the causative agent in order to establish the most appropriate antimicrobial treatment options.