title: Should draining wounds and sinuses associated with hip and knee arthroplasties be cultured?
abstract: We assessed the utility of culturing draining wounds or sinuses in evaluating periprosthetic joint infection (PJI). Fifty-five patients with a draining wound or sinus after total joint arthroplasty (28 knees, 27 hips) who had not received antibiotics for at least two weeks were prospectively studied. Superficial wound cultures were compared to intra-articular cultures to determine accuracy in isolating infecting organism(s). The superficial cultures were concordant with deep cultures in 26 of 55 cases (47.3%) and were more likely to generate polymicrobial results (27.3% vs. 10.9%; P=0.023). In 23 cases (41.8%), the superficial cultures would have led to a change in antibiotic regimen. Superficial cultures yielded bacterial growth in 8 of the 10 cases (80%) when deep cultures and further work-up suggested the absence of deep infection. Given the potential to misguide diagnosis and treatment, we recommend against obtainment of superficial cultures in patients with a draining wound or sinus following hip or knee arthroplasty.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Tetreault
authors.forename: Nathan G
authors.initials: NG
authors.lastname: Wetters
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Aggarwal
authors.forename: Mario
authors.initials: M
authors.lastname: Moric
authors.forename: John
authors.initials: J
authors.lastname: Segreti
authors.forename: James I
authors.initials: JI
authors.lastname: Huddleston
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Della Valle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015331:Cohort Studies; D000075202:Contraindications; D004322:Drainage; D005260:Female; D006621:Hip Joint / Q000382:microbiology / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000382:microbiology / Q000601:surgery; D008297:Male; D008828:Microbiological Techniques / Q000706:statistics & numerical data*; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: periprosthetic joint infection; sinus tract cultures; total hip arthroplasty; total knee arthroplasty; wound cultures