Transcript Diagnosis of Periprosthetic Infection by Using ESR and CRP

Benjamin Bender MD
Ashok Gowda BS
Khalid Azzam MD
Elie Ghanem MD
James Purtill MD
Javad Parvizi MD, FRCS
Rothman Institute
Thomas Jefferson University Hospital
Philadelphia, PA
Periprosthetic joint infection
(PJI)
 1.5%–2.5% after primary hip or knee
arthroplasty
 Marked morbidity and mortality
 Challenging
Periprosthetic joint infection (PJI)
Effective delivery of antibiotics
Based on the type and antibiotic
sensitivity of the infecting
organism
This study reports
 The high false negative rate of microbiological
studies
And
 Compares the outcome of treatment for PJI
when the organism was identified versus
culture negative cases.
Methods/Materials
Patients with PJI between 1999
to 2006
Electronic microbiological
database (1999)
Detailed review of medical
records
Methods/Materials
384 patients (189 women/195
men)
219 knee / 165 hip
Mean age 66.6 years (17-94)
Materials and Methods
Criteria for diagnosis of infection:
 Positive preoperative aspiration Cultures,
Gram stains
 Positive intraoperative Cultures, Gram
stains
and/or
 the presence of an abscess or sinus tract
communicating with the joint space
 Clinical suspicion
 Abnormal serology
Procedure performed
Procedure
Number
Percent
Tw0-stage exchange
242
63%
One-stage exchange
33
9%
I&D
102
26%
Amputation
1
0.3%
Other
6
1.7%
Results
 Gram positive cocci cause 90% of PJI, and gram
negative organisms account for most of the remaining
infections.
 Gram positive in 269 cases (89.7%)
 Gram negative in 30 cases (10%)
 Fungus in 1 case (0.3%)
Results-Intraoperative cultures
Diagnosis of PJI was based on
 Positive Intraoperative cultures in 309 patients (80%)
 20% False Negative
ResultsIntraoperative GRAM STAIN
 340 patients-89%-had Gram stain performed
 71 patients had Positive result-( 21%)
 269 patients – (79%) False Negative
Results- Gram Stain
(Aspiration)
276 patients -72% had pre-operative Aspiration
 93 patients (34 %) had positive GRAM stains
 217 patients (66%) had false negative results
Results- Culture(Aspiration)
276 patients -72% had pre-operative Aspiration
 217 patients (79%) had Positive CULTURE results
 59 patients (21%) had false negative results
Results-Overall
Gram Stain
Culture
Aspiration
34%
79%
Intra-Operative
21%
80%
Results
 Cultures were negative overall in 53 cases (14%) that
satisfied defined criteria for diagnosis of PJI
 Infecting Organism was identified in 331 cases(86%)
GRAM STAIN
Aspiration
No. of
Patients
276 (72%)
Intra-Operative
340 (89%)
Positive
Result
93 (34%)
71 (21%)
False
Negative
183(66%)
269 (79%)
CULTURE
Aspiration
276 (72%)
217 (79%)
59 (21%)
Intra-operative
384 (100%)
300 (80%)
84 (20%)
OVERALL
384(100%)
333 (86%)
51 (14%)
Results-Outcome
•SF-36
•WOMAC
•HSS/KSS
Better for culture positive
•Success for eradication of infection
Better for culture positive
85% vs 75% for false negative
Conclusions

The inability to isolate an
infecting organism causing
periprosthetic joint infection
appears to compromise the
outcome of surgical treatment
Conclusions
 The reason for the inability to isolate the infecting
organism may be multi-factorial
 Important of which relates to the use of antibiotics
at the time of or close to the date of aspiration or
tissue culture.
Conclusion
 Every effort should be made to isolate the infecting
organism whenever possible
This includes
 Cessation of antibiotics for sufficient time prior to
aspiration, repeat aspiration
 Utilization of molecular techniques for isolation of
the organism.
THANK
YOU
PHILADELPHIA, PA 19107, USA