title: Multiple cultures and extended incubation for hip and knee arthroplasty revision: impact on clinical care.
abstract: The impact on patient care of introducing a protocol of obtaining 5 or more intra-operative separate tissue biopsies that were cultured for 10 days was assessed for hip and knee arthroplasty revision. The charts of seventy-three patients undergoing 77 cases of revision arthroplasty were reviewed one year post-operatively. When compared to the prior standard of obtaining only one intra-operative culture, the protocol changed the microbiological diagnosis in 26/77 cases (34%, 95% Confidence Interval (CI): 23-45%) and antibiotic treatment in 23/77 cases (30%, 95% CI: 20-41%). In addition, the protocol had a predictive value of joint sterility in culture negative cases of 95% (95% CI: 85-99%). This data demonstrated the new protocol significantly changed patient care, and suggests that 1 or 2 cultures are insufficient. Adopting a similar protocol should be considered by surgeons and institutions as a new minimum standard for management of prosthetic joint infections.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon.
authors.forename: Alexander
authors.initials: A
authors.lastname: DeHaan
authors.forename: Thomas
authors.initials: T
authors.lastname: Huff
authors.forename: Kathryn
authors.initials: K
authors.lastname: Schabel
authors.forename: Yee-Cheen
authors.initials: YC
authors.lastname: Doung
authors.forename: James
authors.initials: J
authors.lastname: Hayden
authors.forename: Penelope
authors.initials: P
authors.lastname: Barnes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation; D001706:Biopsy; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D006622:Hip Prosthesis / Q000382:microbiology*; D006801:Humans; D007432:Intraoperative Period; D007719:Knee Joint / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D007720:Knee Prosthesis / Q000382:microbiology*; D008297:Male; D008828:Microbiological Techniques / Q000379:methods*; D008875:Middle Aged; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: hip arthroplasty; infection; knee arthroplasty; multiple cultures; revision arthroplasty