CORR Insights^®: Premature Therapeutic Antimicrobial Treatments Can Compromise the Diagnosis of Late Periprosthetic Joint Infection

Excerpt

Lacking definitive standards, the Musculoskeletal Infection Society (MSIS) created a definition for the diagnosis of periprosthetic joint infection (PJI), which was subsequently modified during the International Consensus meeting on PJI in 2013 [4]. The diagnostic criteria are based on both clinical and laboratory findings, and are considered more helpful than any single test might be in terms of reaching the diagnosis of PJI. However, the diagnostic picture may be confounded in cases when patients are on antibiotic therapy, which previous research has shown to be a risk factor for culture-negative PJI [3]. The recommendations by the American Academy of Orthopaedic Surgeons (AAOS) in their clinical practice guidelines discourage the use of antimicrobial treatments in patients with suspected PJI until after aspiration samples for intraoperative cultures are obtained. The AAOS also recommends withholding antibiotics for at least 2 weeks before intraarticular sample collection for culture if antibiotics have already been given [2]. However, in spite of these guidelines, some patients present for evaluation of suspected PJI having already been exposed to antibiotics. Unfortunately, we have no data to guide our interpretation of laboratory parameters such as serologic results and synovial fluid analysis in patients who had antibiotics prior to completion of a thorough workup for PJI. …