Research culture methods detect more anaerobes compared to conventional clinical workflows in periprosthetic joint infection: a pilot study of 14 cases.
7 affiliations
- 1Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, USA. [email protected].
- 2Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, USA.
- 3Department of Infectious Disease, Cleveland Clinic, Cleveland, USA.
- 4Department of Microbial Sciences in Health, Cleveland Clinic, Cleveland, USA.
- 5A*STAR Infectious Diseases Labs, Singapore, Singapore.
- 6Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- 7Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, USA. [email protected].
Abstract
Introduction
Periprosthetic joint infection (PJI) remains one of the most challenging complications of total joint arthroplasty, often complicated by limitations in diagnostic sensitivity. Standard clinical culture methods fail to identify pathogens in 20%-50% of cases, leading to potential under- or overtreatment. This pilot study aimed to compare the microbial detection capabilities of standard clinical culture methods with enhanced research laboratory techniques, and to explore whether additional microbial findings might have the potential to influence antibiotic treatment planning.Materials and methods
Thirteen patients undergoing surgery for PJI, as defined by the 2018 International Consensus Meeting (ICM) on Infection criteria, were prospectively enrolled at a single academic medical center between August 2023 and September 2024. Intraoperative synovial fluid, periprosthetic tissue, and implant swabs were collected and processed using both standard clinical workflows and optimized research protocols. Culture results and treatment decisions were reviewed in collaboration with Infectious Disease specialists.Results
Both methods identified primary organisms. However, research techniques detected additional organisms not captured by clinical cultures (p = 0.013). Despite these differences, overall detection rates were comparable (57.1% vs. 59.5%; p = 0.963), with the research workflow achieving similar yield with fewer samples. The potential impact of additional isolate identification on antibiotic selection, if deemed clinically significant, did not appear to result in meaningful changes to antibiotic regimens, although this may have been influenced by the empiric use broad-spectrum antibiotics.Conclusions
Clinical culture methods may not detect all organisms in PJI, highlighting possible limitations in current diagnostic approaches. Although this pilot study did not directly assess the impact of enhanced microbial detection on antibiotic prescribing and treatment decisions were largely unchanged, these findings suggest that a more comprehensive microbial detection could potentially inform antibiotic selection and warrants further investigation.
Related
- Culture-Specific Outcomes of Intra-Articular Antibiotic Infusion With Implant-Retaining Debridement for Periprosthetic Joint Infection After Unicompartmental Knee Arthroplasty
- From Measured Accuracy to Patient Outcome: Navigation in Total Hip Arthroplasty and Molecular Diagnosis of Periprosthetic Joint Infection: A Narrative Review
- Extensor Mechanism Reconstruction Following Periprosthetic Joint Infection After Total Knee Arthroplasty: A Systematic Review
- Antibiotic-Loaded Hydrogel, Calcium Bead, and Cement in Periprosthetic Joint Infection Following Hip-Knee Arthroplasty: A Systematic Review and Meta-Analysis of Commercially Available Products
- Retrospective analysis of LAG3, TIGIT, TIM3 and VISTA immune checkpoints expression in hip and knee periprosthetic joint infection
BibTeX
@article{visperas2026research,
title = {{Research culture methods detect more anaerobes compared to conventional clinical workflows in periprosthetic joint infection: a pilot study of 14 cases.}},
author = {Anabelle Visperas and Qiuhe Lu and Bethany Lehman and Suan Sin Foo and Weiqiang Chen and Vidula Vachharajani and Thaddeus Stappenbeck and Nicolas Piuzzi},
journal = {Archives of orthopaedic and trauma surgery},
year = {2026},
month = oct,
doi = {10.1007/s00402-026-06550-7},
url = {https://europepmc.org/article/MED/42963491},
note = {CC BY},
}
RIS
TY - JOUR
TI - Research culture methods detect more anaerobes compared to conventional clinical workflows in periprosthetic joint infection: a pilot study of 14 cases.
AU - Anabelle Visperas
AU - Qiuhe Lu
AU - Bethany Lehman
AU - Suan Sin Foo
AU - Weiqiang Chen
AU - Vidula Vachharajani
AU - Thaddeus Stappenbeck
AU - Nicolas Piuzzi
PY - 2026
DA - 2026/10/31
JO - Archives of orthopaedic and trauma surgery
DO - 10.1007/s00402-026-06550-7
UR - https://europepmc.org/article/MED/42963491
AB - Introduction Periprosthetic joint infection (PJI) remains one of the most challenging complications of total joint arthroplasty, often complicated by limitations in diagnostic sensitivity. Standard clinical culture methods fail to identify pathogens in 20%-50% of cases, leading to potential under- or overtreatment. This pilot study aimed to compare the microbial detection capabilities of standard clinical culture methods with enhanced research laboratory techniques, and to explore whether additional microbial findings might have the potential to influence antibiotic treatment planning.Materials and methods Thirteen patients undergoing surgery for PJI, as defined by the 2018 International Consensus Meeting (ICM) on Infection criteria, were prospectively enrolled at a single academic medical center between August 2023 and September 2024. Intraoperative synovial fluid, periprosthetic tissue, and implant swabs were collected and processed using both standard clinical workflows and optimized research protocols. Culture results and treatment decisions were reviewed in collaboration with Infectious Disease specialists.Results Both methods identified primary organisms. However, research techniques detected additional organisms not captured by clinical cultures (p = 0.013). Despite these differences, overall detection rates were comparable (57.1% vs. 59.5%; p = 0.963), with the research workflow achieving similar yield with fewer samples. The potential impact of additional isolate identification on antibiotic selection, if deemed clinically significant, did not appear to result in meaningful changes to antibiotic regimens, although this may have been influenced by the empiric use broad-spectrum antibiotics.Conclusions Clinical culture methods may not detect all organisms in PJI, highlighting possible limitations in current diagnostic approaches. Although this pilot study did not directly assess the impact of enhanced microbial detection on antibiotic prescribing and treatment decisions were largely unchanged, these findings suggest that a more comprehensive microbial detection could potentially inform antibiotic selection and warrants further investigation.
SN - 0936-8051
SN - 1434-3916
ER -