Positive Blood Cultures in Periprosthetic Joint Infection Decrease Rate of Treatment Success

Background

Blood cultures are often obtained at the time of periprosthetic joint infection (PJI) diagnosis yet they are not considered part of the diagnostic criteria and the effects of a positive result on surgical outcome are unknown. The purposes of this study are to characterize the use of blood cultures when diagnosing PJI and to determine the association of positive blood cultures with PJI treatment success.

Methods

A retrospective chart review on 320 patients surgically treated for primary hip and knee PJIs was performed from 2006-2013 at 2 academic medical centers with minimum 12-month follow-up. Treatment success was defined by the Delphi criteria. Multiple logistic regression analysis was performed to identify variables associated with treatment success.

Results

Blood cultures were obtained from 53.1% of PJI patients (170/320) at the time of diagnosis. The same organism was identified 86.0% of the time in blood culture and operative culture. Patients with positive blood cultures at the time of PJI diagnosis had elevated synovial white blood cell count (98,979, P = .012), elevated serum C-reactive protein (24.2 mg/L, P < .001), and decreased treatment success (65.1%) compared with those with a negative blood culture (85.0%) and those without a blood culture (82.7%, P = .013). A positive blood culture remained associated with decreased PJI treatment success using multiple logistic regression analysis.

Conclusion

The presence of positive blood cultures at the time of PJI diagnosis decreased PJI treatment success. Further prospective studies are needed to help identify the role of blood cultures in the work up of PJI and treatment optimization in these patients.