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Prior Use of Antimicrobial Therapy is a Risk Factor for Culture-negative Prosthetic Joint Infection

  • Symposium: Papers Presented at the 2009 Meeting of the Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Clinical characteristics and control of the infection of patients with culture-negative (CN) prosthetic joint infection (PJI) have not been well assessed. Prior use of antimicrobial therapy has been speculated but not proven as a risk factor for CNPJI.

Questions/purposes

We therefore determined whether prior use of antimicrobial therapy, prior PJI, and postoperative wound healing complications were associated with CN PJI.

Methods

We performed a retrospective case-control study of 135 patients with CN PJI treated between January 1, 1985, and December 31, 2000 matched with 135 patients with culture-positive (CP) PJIs (control patients) during the study period. The time to failure of therapy compared between cases and control patients using a Kaplan-Meier analysis.

Results

The use of prior antimicrobial therapy and postoperative wound drainage after index arthroplasty were associated with increased odds of PJI being culture-negative (odds ratio, 4.7; 95% CI, 2.8–8.1 and odds ratio, 3.5; 95% CI, 1.5–8.1, respectively). The percent (± SE) cumulative incidence free of treatment failure at 2 years followup was similar for CN and CP PJI: 75% (± 4%) and 79% (± 4%), respectively.

Conclusions

Prior antimicrobial therapy and postoperative wound drainage were associated with an increased risk of negative cultures among patients with PJI. Physicians should critically evaluate the need for antimicrobial therapy before establishing a microbiologic diagnosis of PJI in patients with suspected PJI.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank other members of the Mayo PJI study group: Robin Patel, James Steckelberg, Jeanette Eckel-Passow, Irene Sia, and Mary Duffy for their help in the design, data collection, analysis, and review of the final manuscript.

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Authors and Affiliations

  1. Paracelsus Medical Privatuniversity, Salzburg, Austria

    Davud Malekzadeh

  2. Section of Orthopedic Infectious Diseases, Mayo Clinic College of Medicine, 200 First Street NW, Rochester, MN, 55902, USA

    Douglas R. Osmon MD, MPH & Elie F. Berbari MD

  3. Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, MN, USA

    Brian D. Lahr MS

  4. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Arlen D. Hanssen MD

Authors
  1. Davud Malekzadeh
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  2. Douglas R. Osmon MD, MPH
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  3. Brian D. Lahr MS
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  4. Arlen D. Hanssen MD
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  5. Elie F. Berbari MD
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Corresponding author

Correspondence to Elie F. Berbari MD.

Additional information

Mayo PJI Study Group

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Mayo Clinic, Rochester, MN, USA.

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Malekzadeh, D., Osmon, D.R., Lahr, B.D. et al. Prior Use of Antimicrobial Therapy is a Risk Factor for Culture-negative Prosthetic Joint Infection. Clin Orthop Relat Res 468, 2039–2045 (2010). https://doi.org/10.1007/s11999-010-1338-0

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  • DOI: https://doi.org/10.1007/s11999-010-1338-0

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