A Review of the Literature on Culture-Negative Periprosthetic Joint Infection: Epidemiology, Diagnosis and Treatment

The prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification of causative microorganisms is crucial for treatment of PJI, culture-negative (CN) PJI is a significant clinical issue. The purpose of the present st...

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Published in:	Knee Surgery and Related Research, 29(3) Vol. 29; no. 3; pp. 155 - 164
Main Authors:	Yoon, Hong-Kwon, Cho, Seong-Hee, Lee, Dong-Yeong, Kang, Byeong-Hun, Lee, Sang-Hyuk, Moon, Dong-Gyu, Kim, Dong-Hee, Nam, Dae-Cheol, Hwang, Sun-Chul
Format:	Journal Article
Language:	English
Published:	Korea (South) Korean Knee Society 01-09-2017 대한슬관절학회
Subjects:	Review 정형외과학 Infection Arthroplasty Review Culture
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Abstract	The prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification of causative microorganisms is crucial for treatment of PJI, culture-negative (CN) PJI is a significant clinical issue. The purpose of the present study is to describe epidemiology, diagnosis and treatment of CN PJI based on review of the literature to help prevent delayed diagnosis and improve clinical outcomes of CN PJI. MEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for articles on CN PJI. Only clinical studies written in English were included. Basic science studies, letters to the editor, case reports and review articles on PJI were excluded. Seven studies were included in this study. The prevalence of CN PJI ranged from 0% to 42.1%. The major risk factors for CN PJI were prior antibiotic use and presence of postoperative wound drainage. Vancomycin and cephalosporins were the most commonly used antibiotics for CN PJI. Two-stage revision arthroplasty followed by 6 weeks of antibiotic therapy produced the most successful treatment outcomes. In most clinical studies on CN PJI, a definite diagnostic method for identifying causative microorganisms or optimal treatment strategy for CN PJI were not clearly described. Therefore, further studies are needed to establish standard diagnostic methods for identifying infecting organisms and treatment strategies for CN PJI.
AbstractList	PurposeThe prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification of causative microorganisms is crucial for treatment of PJI, culture-negative (CN) PJI is a significant clinical issue. The purpose of the present study is to describe epidemiology, diagnosis and treatment of CN PJI based on review of the literature to help prevent delayed diagnosis and improve clinical outcomes of CN PJI. MethodsMEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for articles on CN PJI. Only clinical studies written in English were included. Basic science studies, letters to the editor, case reports and review articles on PJI were excluded. ResultsSeven studies were included in this study. The prevalence of CN PJI ranged from 0% to 42.1%. The major risk factors for CN PJI were prior antibiotic use and presence of postoperative wound drainage. Vancomycin and cephalosporins were the most commonly used antibiotics for CN PJI. Two-stage revision arthroplasty followed by 6 weeks of antibiotic therapy produced the most successful treatment outcomes. ConclusionsIn most clinical studies on CN PJI, a definite diagnostic method for identifying causative microorganisms or optimal treatment strategy for CN PJI were not clearly described. Therefore, further studies are needed to establish standard diagnostic methods for identifying infecting organisms and treatment strategies for CN PJI. Purpose: The prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification of causative microorganisms is crucial for treatment of PJI, culturenegative (CN) PJI is a significant clinical issue. The purpose of the present study is to describe epidemiology, diagnosis and treatment of CN PJI based on review of the literature to help prevent delayed diagnosis and improve clinical outcomes of CN PJI. Methods: MEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for articles on CN PJI. Only clinical studies written in English were included. Basic science studies, letters to the editor, case reports and review articles on PJI were excluded. Results: Seven studies were included in this study. The prevalence of CN PJI ranged from 0% to 42.1%. The major risk factors for CN PJI were prior antibiotic use and presence of postoperative wound drainage. Vancomycin and cephalosporins were the most commonly used antibiotics for CN PJI. Twostage revision arthroplasty followed by 6 weeks of antibiotic therapy produced the most successful treatment outcomes. Conclusions: In most clinical studies on CN PJI, a definite diagnostic method for identifying causative microorganisms or optimal treatment strategy for CN PJI were not clearly described. Therefore, further studies are needed to establish standard diagnostic methods for identifying infecting organisms and treatment strategies for CN PJI. KCI Citation Count: 2 The prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification of causative microorganisms is crucial for treatment of PJI, culture-negative (CN) PJI is a significant clinical issue. The purpose of the present study is to describe epidemiology, diagnosis and treatment of CN PJI based on review of the literature to help prevent delayed diagnosis and improve clinical outcomes of CN PJI. MEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for articles on CN PJI. Only clinical studies written in English were included. Basic science studies, letters to the editor, case reports and review articles on PJI were excluded. Seven studies were included in this study. The prevalence of CN PJI ranged from 0% to 42.1%. The major risk factors for CN PJI were prior antibiotic use and presence of postoperative wound drainage. Vancomycin and cephalosporins were the most commonly used antibiotics for CN PJI. Two-stage revision arthroplasty followed by 6 weeks of antibiotic therapy produced the most successful treatment outcomes. In most clinical studies on CN PJI, a definite diagnostic method for identifying causative microorganisms or optimal treatment strategy for CN PJI were not clearly described. Therefore, further studies are needed to establish standard diagnostic methods for identifying infecting organisms and treatment strategies for CN PJI.
Author	Nam, Dae-Cheol Kim, Dong-Hee Lee, Dong-Yeong Lee, Sang-Hyuk Moon, Dong-Gyu Hwang, Sun-Chul Cho, Seong-Hee Yoon, Hong-Kwon Kang, Byeong-Hun
AuthorAffiliation	2 Department of Orthopaedic Surgery, Gangneung Armed Hospital, Gangneung, Korea 3 Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea 1 Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
AuthorAffiliation_xml	– name: 1 Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea – name: 3 Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea – name: 2 Department of Orthopaedic Surgery, Gangneung Armed Hospital, Gangneung, Korea
Author_xml	– sequence: 1 givenname: Hong-Kwon surname: Yoon fullname: Yoon, Hong-Kwon organization: Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea – sequence: 2 givenname: Seong-Hee surname: Cho fullname: Cho, Seong-Hee organization: Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea – sequence: 3 givenname: Dong-Yeong surname: Lee fullname: Lee, Dong-Yeong organization: Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea – sequence: 4 givenname: Byeong-Hun surname: Kang fullname: Kang, Byeong-Hun organization: Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea – sequence: 5 givenname: Sang-Hyuk surname: Lee fullname: Lee, Sang-Hyuk organization: Department of Orthopaedic Surgery, Gangneung Armed Hospital, Gangneung, Korea – sequence: 6 givenname: Dong-Gyu surname: Moon fullname: Moon, Dong-Gyu organization: Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea – sequence: 7 givenname: Dong-Hee surname: Kim fullname: Kim, Dong-Hee organization: Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea – sequence: 8 givenname: Dae-Cheol surname: Nam fullname: Nam, Dae-Cheol organization: Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea – sequence: 9 givenname: Sun-Chul surname: Hwang fullname: Hwang, Sun-Chul organization: Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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Snippet	The prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification of... PurposeThe prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification... Purpose: The prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification...
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Title	A Review of the Literature on Culture-Negative Periprosthetic Joint Infection: Epidemiology, Diagnosis and Treatment
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ispartofPNX	Knee Surgery and Related Research, 2017, 29(3), , pp.155-164
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