Adherence to a reliable PJI diagnostic protocol minimizes unsuspected positive cultures rate
Pérez-Prieto, Daniel (Parc de Salut MAR de Barcelona)
Hinarejos Gómez, Pedro (Parc de Salut MAR de Barcelona)
Alier, Albert (Parc de Salut MAR de Barcelona)
Sorlí, Luisa (Parc de Salut MAR de Barcelona)
Martínez, Santos (Parc de Salut MAR de Barcelona)
Puig Sanz, Lluís (Parc de Salut MAR de Barcelona)
Monllau García, Joan Carles (Universitat Autònoma de Barcelona. Departament de Cirurgia)

Data:	2021
Resum:	The aim of the present study was to evaluate the incidence of unsuspected PJI when prosthetic revisions are thoroughly evaluated by PJI dedicated orthopedic surgeon before surgery. The hypothesis is that the incidence of unsuspected PJI is reduced by applying this protocol. This is a historical cohort study carried out in one university hospital. The prosthetic revision assessment was carried out in January 2019. From that date on, all patients that were programmed for hip or knee revision (either by an orthopedic surgeon specialized or not in septic revisions) were scheduled for a preoperative visit with the same orthopedic surgeon specialized in septic revisions. The diagnostic algorithm applied was based on the Pro-Implant Foundation diagnostic criteria. Prior to the revision assessment, the indication for joint aspiration was done at the surgeons' discretion (non-specialized in septic revisions) and the preoperative identification of PJI was also done by a hip or knee surgeon (not specialized in septic surgery). Based on the PIF criteria, there were 15 infections among the revisions in group 1 and 18 PJI in group 2 (p > 0. 05). The most interesting finding was that there were 7 patients with unsuspected positive cultures in group 1. That represents 11% of all revisions. No patient in group 2 was found with unsuspected positive cultures (p < 0. 001). A thorough PJI diagnostic algorithm should be implemented before prosthetic revision to avoid unsuspected positive cultures.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	PJI diagnosis ; Culture-negative-PJI ; Unsuspected positive cultures
Publicat a:	BMC musculoskeletal disorders, Vol. 22 (august 2021) , ISSN 1471-2474

DOI: 10.1186/s12891-021-04431-1
PMID: 34340666

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