Abstract
Introduction: The primary aim of this study was to determine whether the tissue type and anatomical location of intra-operative samples influences the accuracy of culture in the diagnosis of periprosthetic joint infection (PJI). The secondary aim was to create a predictive model of PJI using other known patient variables.Methods: A retrospective cohort of 3460 intra-operative samples from 887 patients was identified. The data was then analysed to compare intra-operative culture results (positive or negative) to the chosen gold standard of clinical diagnosis made by the treating team (infected or non-infected prosthetic joint). The intra-operative samples were grouped according to their labelling at the time of collection.Results: No single tissue type or anatomical location had both high sensitivity and specificity. The highest specificity for an anatomical location was hip bursa with 100%, for tissue type it was synovium with 93%. Sensitivity was highest in the anatomical locations for hip capsule (68%) and in the tissue types for pus (83%). Data analysis was performed to create a model for PJI and identified pre-operative predictors of PJI (increased white cell count, knee joint and non-revision surgery) which when used in combination with intra-operative culture results increased the sensitivity.Conclusion: Sample type and anatomical location influenced the reliability of the diagnosis of PJI however, no single sample type had higher diagnostic accuracy than samples combined thereby highlighting the necessity of obtaining multiple intra-operative samples in the diagnosis of PJI. The variation in predictive values of tissue types as well as improvement in sensitivity when combined with patient factors indicates that types of intra-operative sampling and the overall diagnostic pathway should vary depending on the individual case.
Highlights
The primary aim of this study was to determine whether the tissue type and anatomical location of intra-operative samples influences the accuracy of culture in the diagnosis of periprosthetic joint infection (PJI)
An incorrect diagnosis of PJI may lead to an unnecessary surgical procedure [6] whereas not recognising PJI will result in early implant failure with an untreated infection [7]
The patient cohort was identified from the Laboratory Information Management System (LIMS) by using search tool Cognos [23] to identify all culture samples codes logged from patients who had been admitted to one of the centre’s two orthopaedic wards at the time the sample was taken
Summary
The primary aim of this study was to determine whether the tissue type and anatomical location of intra-operative samples influences the accuracy of culture in the diagnosis of periprosthetic joint infection (PJI). Culture results are considered extremely useful as they provide a diagnosis and identify the specific pathogens and sensitivity profiles [3,4,5]. Sampling of joint fluid through aspiration has variable results with a wide range of reported sensitivities (50-93%) and specificities (82-97%) [18]. Superficial wound fluid samples have been shown to have poor accuracy in the diagnosis of PJI. Evidence suggests that in order to maximise the sensitivity and specificity of intra-operative specimen cultures at least five or six specimens should be obtained during surgery [19]
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