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Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Austria
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Prosthetic joint infections (PJI) can be difficult to diagnose.
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Studies have shown that we are missing many infections, possibly due to poor diagnostic workup and the presence of culture-negative infection.
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PJI diagnosis requires a methodical approach and a standardised set of criteria.
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Multiple PJI definitions have been published with improved accuracy in recent years.
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The new European Bone and Joint Infection Society definition offers some advantages in clinical practice. It identifies more clinically important infections and accurately defines those with the highest risk of treatment failure. It reduces the number of patients with uncertain diagnoses.
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Classification of PJIs may offer a better understanding of treatment outcomes and risk factors for failure.
Porto Bone and Joint Infection Group (GRIP), Centro Hospitalar Universitário do Porto and Grupo TrofaSaude, Portugal
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Department of Microbiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Department of Microbiology, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Infection is a dire complication afflicting every field of orthopaedics and traumatology. If specific clinical, laboratory and imaging parameters are present, infection is often assumed even in the absence of microbiological confirmation. However, apart from confirming infection, knowing the exact infecting pathogen(s) and their antimicrobial susceptibility patterns is paramount to help guide treatment. Every effort should therefore be undertaken with that goal in mind.
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Not all microbiological findings carry the same relevance, and knowing exactly how and where a sample was collected is key. Several different sampling techniques are available, and one must be aware of both advantages and limitations. Microbiological sampling alternatives in some of the most common clinical scenarios such as native and prosthetic joint infections, osteomyelitis and fracture-related infections, spinal and diabetic foot infections will be discussed.
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Orthopaedic surgeons should also be aware of basic laboratory sample processing techniques as they have a direct impact on the way specimens should be dealt with and transported to the laboratory. Only by knowing these basic principles will surgeons be able to participate in the multidisciplinary discussion and decision making around how to interpret microbiological findings in each specific patient.
Cite this article: EFORT Open Rev 2021;6:390-398. DOI: 10.1302/2058-5241.6.210011
