alexa Culture Negative Prosthetic Joint Infection–A Description of Current Treatment and Outcomes
ISSN: 2327-5073

Clinical Microbiology: Open Access
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Research Article

Culture Negative Prosthetic Joint Infection–A Description of Current Treatment and Outcomes

Trisha N Peel1,2*, Michelle M Dowsey1,3, Craig A Aboltins2, John R Daffy2, Peter A Stanley2, Kirsty L Buising2 and Peter FM1,3

1Department of Surgery, St Vincent’s Hospital, University of Melbourne, Fitzroy, Victoria, Australia

2Department of Infectious Diseases, St Vincent’s Hospital, Fitzroy, Victoria, Australia

3Department of Orthopaedic Surgery, St Vincent’s Hospital, Fitzroy, Victoria, Australia

*Corresponding Author:
Trisha N Peel
Department of Surgery, St Vincent’s Hospital
University of Melbourne, 29 Regent Street
Fitzroy, Melbourne, Victoria 3065, Australia
Tel: 61-3-9288-2211
Fax: 61-3-9288-2571
E-mail: [email protected]

Received Date: February 01, 2013; Accepted Date: March 27, 2013; Published Date: March 31, 2013

Citation: Peel TN, Dowsey MM, Aboltins CA, Daffy JR, Stanley PA, et al. (2013) Culture Negative Prosthetic Joint Infection–A Description of Current Treatment and Outcomes. Clin Microbial 2:106. doi:10.4172/2327-5073.1000106

Copyright: © 2013 Peel TN, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



Background: The management of prosthetic joint infections remains a clinical challenge particularly when standard aerobic and anaerobic culture techniques fail to isolate the causative pathogen, so called ‘culture negative prosthetic joint infection’ (CNPJI). There are few studies detailing approaches to management in this cohort of patients. This study reports the treatment and outcomes of 19 patients with CNPJI. Results: The majority of patients (68%) with CNPJI had exposure to antibiotic therapy in the week prior to presentation with CNPJI. Patients with early (10 patients) and haematogenous (3 patients) CNPJI were treated with debridement and retention of the prosthesis. In contrast, patients with delayed and late chronic CNPJI (6 patients) were managed by two-stage exchange. In addition to the surgical management patients were commenced on broadspectrum oral antibiotics combination therapy with rifampicin, fusidic acid +/- ciprofloxacin for a prolonged duration (median 7 months; interquartile range 3-20). Patients were followed up for a median of 19 months (interquartile range 13-29). Two patients experienced treatment failure with a 12 month estimate of infection free survival of 95% (95% confidence interval: 68,99). Of concern, 28% patients receiving oral antibiotics experienced adverse effects necessitating change in treatment. Conclusions: In this cohort, the outcomes for patients with CNPJI were comparable to those reported for culture positive infections, and contrary to previous recommendations, this study demonstrates that debridement and retention of a CNPJI is reasonable for patients with early infections. It also highlights the importance of exclusion of prosthetic joint infection prior to instigation of antibiotic therapy to optimise peri-prosthetic tissue culture yields to avoid this situation in which multiple broad spectrum antibiotics with potential side effects become necessary

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