Browning Sarah, Manning Laurens, Metcalf Sarah, Paterson David L, Robinson James O, Clark Benjamin, Davis Joshua S
Infection Research Program, Hunter Medical Research Institute, Newcastle, Australia.
School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
J Bone Jt Infect. 2022 Sep 20;7(5):203-211. doi: 10.5194/jbji-7-203-2022. eCollection 2022.
: Culture-negative (CN) prosthetic joint infections (PJIs) account for approximately 10 % of all PJIs and present significant challenges for clinicians. We aimed to explore the significance of CN PJIs within a large prospective cohort study, comparing their characteristics and outcomes with culture-positive (CP) cases. : The Prosthetic joint Infection in Australia and New Zealand Observational (PIANO) study is a prospective, multicentre observational cohort study that was conducted at 27 hospitals between 2014 and 2017. We compared baseline characteristics and outcomes of all patients with CN PJI from the PIANO cohort with those of CP cases. We report on PJI diagnostic criteria in the CN cohort and apply internationally recognized PJI diagnostic guidelines to determine optimal CN PJI detection methods. : Of the 650 patients with 24-month outcome data available, 55 (8.5 %) were CN and 595 were CP. Compared with the CP cohort, CN patients were more likely to be female (32 (58.2 %) vs. 245 (41.2 %); 0.016), involve the shoulder joint (5 (9.1 %) vs. 16 (2.7 %); 0.026), and have a lower mean C-reactive protein (142 mg L vs. 187 mg L ; 0.016). Overall, outcomes were superior in CN patients, with culture negativity an independent predictor of treatment success at 24 months (adjusted odds ratio, aOR, of 3.78 and 95 %CI of 1.65-8.67). Suboptimal diagnostic sampling was common in both cohorts, with CN PJI case detection enhanced using the Infectious Diseases Society of America PJI diagnostic guidelines. : Current PJI diagnostic guidelines vary substantially in their ability to detect CN PJI, with comprehensive diagnostic sampling necessary to achieve diagnostic certainty. Definitive surgical management strategies should be determined by careful assessment of infection type, rather than by culture status alone.
培养阴性（CN）人工关节感染（PJI）约占所有PJI的10%，给临床医生带来了重大挑战。我们旨在通过一项大型前瞻性队列研究探讨CN PJI的意义，将其特征和结果与培养阳性（CP）病例进行比较。：澳大利亚和新西兰人工关节感染观察性（PIANO）研究是一项前瞻性、多中心观察性队列研究，于2014年至2017年在27家医院进行。我们将PIANO队列中所有CN PJI患者的基线特征和结果与CP病例进行了比较。我们报告了CN队列中的PJI诊断标准，并应用国际认可的PJI诊断指南来确定最佳的CN PJI检测方法。：在有24个月结局数据的650例患者中，55例（8.5%）为CN，595例为CP。与CP队列相比，CN患者更可能为女性（32例（58.2%）对245例（41.2%）；P = 0.016），累及肩关节（5例（9.1%）对16例（2.7%）；P = 0.026），且平均C反应蛋白水平较低（142mg/L对187mg/L；P = 0.016）。总体而言，CN患者的结局更好，培养阴性是24个月治疗成功的独立预测因素（调整优势比，aOR，为3.78，95%CI为1.65 - 8.67）。两个队列中次优诊断采样都很常见，使用美国传染病学会PJI诊断指南可提高CN PJI病例的检测率。：当前的PJI诊断指南在检测CN PJI的能力上有很大差异，需要进行全面的诊断采样以实现诊断的确定性。明确的手术管理策略应通过对感染类型的仔细评估来确定，而不仅仅取决于培养结果。
