Time to positivity of acute and chronic periprosthetic joint infection cultures

D.T Talsma,J.J.W Ploegmakers,P.C Jutte,G Kampinga,M Wouthuyzen-Bakker

doi:10.1016/j.diagmicrobio.2020.115178

Abstract

IntroductionA prolonged incubation time is generally recommended for diagnosing periprosthetic joint infections (PJI). However, in literature, no distinction is made between acute and chronic infections. MethodsAll patients with a PJI that underwent surgical debridement between November 2015 and February 2019 with or without revision of the prosthesis were retrospectively evaluated. Synovial fluid, 5 intraoperative periprosthetic tissue samples, and the sonicated prosthesis were cultured. ResultsFifty-nine patients were analyzed, including 21 acute PJIs (33 isolates) and 38 chronic PJIs (46 isolates). In acute PJIs, all isolates grew within 5 days, while this took 11 days for chronic PJIs. Sonication fluid showed the shortest time to positivity (78% at day 2) for chronic PJIs, but no difference was observed for acute PJIs compared to tissue cultures. ConclusionIn contrast to cultures from chronic PJIs, acute PJIs do not need a prolonged incubation time and no clear benefit is observed for sonication.

Highlights

A prolonged incubation time is generally recommended for diagnosing periprosthetic joint infections (PJI)
A prolonged incubation time of 10 to 14 days is generally recommended for diagnosing PJIs, but in literature no clear distinction is made between acute and chronic PJIs
We retrospectively analyzed whether TTP differs between acute and chronic infections, and found that the TTP of acute PJI cultures are considerably shorter compared to chronic PJI cultures

Summary

Introduction

A prolonged incubation time is generally recommended for diagnosing periprosthetic joint infections (PJI). In acute PJIs, all isolates grew within 5 days, while this took 11 days for chronic PJIs. Sonication fluid showed the shortest time to positivity (78% at day 2) for chronic PJIs, but no difference was observed for acute PJIs compared to tissue cultures. Conclusion: In contrast to cultures from chronic PJIs, acute PJIs do not need a prolonged incubation time and no clear benefit is observed for sonication. While less virulent bacteria like Cutibacterium acnes and Coagulase Negative Staphylococci (CoNS) are associated with more subtle and chronic symptoms like persisting joint pain. Based on these characteristics and the duration of symptoms, PJIs are classified in acute and chronic infections. Acute infections are treated with debridement, antibiotics and implant retention (DAIR) while in chronic infections, the prosthesis needs to be revised (Osmon et al, 2013)

Methods

Results

Conclusion