Postoperative Antibiotic Duration and Treatment Failure After Aseptic Revision Arthroplasty With a Single Unexpected Positive Culture: A Retrospective Cohort Study.
4 affiliations
- 1Department of Orthopedic Surgery, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan, China.
- 2Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, China.
- 3College of Medicine, Chang Gung University, Kaohsiung, Taiwan, China.
- 4Center for General Education, Cheng Shiu University, Kaohsiung, Taiwan, China.
Abstract
Objectives
The clinical significance of a single unexpected positive intraoperative culture (UPC) during aseptic revision arthroplasty remains unclear. This study primarily aimed to evaluate the association between postoperative antibiotic duration and treatment failure in patients with a single UPC after aseptic revision total hip or knee arthroplasty. A secondary aim was to compare failure-free survival between patients with a single UPC and those with multiple UPCs.Methods
We retrospectively reviewed 51 presumed aseptic revision hip or knee arthroplasties with UPCs performed between January 1999 and December 2023. Cases meeting the 2018 ICM criteria for periprosthetic joint infection were excluded. Postoperative antibiotic duration was the exposure of interest. Treatment failure, defined as infection-related re-revision, was the primary outcome; failure-free survival was the secondary outcome. Continuous variables were compared using the Mann-Whitney U test, and categorical variables were compared using chi-square or Fisher's exact tests. Factors associated with failure were examined using univariate logistic regression, and failure-free survival was assessed using Kaplan-Meier analysis with the log-rank test.Results
Among 39 patients with one UPC, treatment failure occurred in 18%. Antibiotic courses longer than 21 days were associated with failure (OR 28.1). In the small subgroup with available data (n = 13), synovial biomarkers did not show a statistically significant difference between success and failure groups. Patients with one UPC had better failure-free survival than those with ≥ 2 UPCs.Conclusion
The observed association between prolonged antibiotic therapy and treatment failure may reflect underlying infection severity rather than a causal effect of antibiotic duration. Individualized management is recommended for UPCs in aseptic revision arthroplasty.
Related
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BibTeX
@article{hsieh2026postoperative,
title = {{Postoperative Antibiotic Duration and Treatment Failure After Aseptic Revision Arthroplasty With a Single Unexpected Positive Culture: A Retrospective Cohort Study.}},
author = {Hao-Chang Hsieh and Feng-Chih Kuo and Allen Herng Shouh Hsu and Shih-Hsiang Yen and Po-Chun Lin and Cheng-Ta Wu},
journal = {Orthopaedic surgery},
year = {2026},
month = oct,
doi = {10.1111/os.70452},
url = {https://europepmc.org/article/MED/42906634},
note = {CC BY},
}
RIS
TY - JOUR
TI - Postoperative Antibiotic Duration and Treatment Failure After Aseptic Revision Arthroplasty With a Single Unexpected Positive Culture: A Retrospective Cohort Study.
AU - Hao-Chang Hsieh
AU - Feng-Chih Kuo
AU - Allen Herng Shouh Hsu
AU - Shih-Hsiang Yen
AU - Po-Chun Lin
AU - Cheng-Ta Wu
PY - 2026
DA - 2026/10/21
JO - Orthopaedic surgery
DO - 10.1111/os.70452
UR - https://europepmc.org/article/MED/42906634
AB - Objectives The clinical significance of a single unexpected positive intraoperative culture (UPC) during aseptic revision arthroplasty remains unclear. This study primarily aimed to evaluate the association between postoperative antibiotic duration and treatment failure in patients with a single UPC after aseptic revision total hip or knee arthroplasty. A secondary aim was to compare failure-free survival between patients with a single UPC and those with multiple UPCs.Methods We retrospectively reviewed 51 presumed aseptic revision hip or knee arthroplasties with UPCs performed between January 1999 and December 2023. Cases meeting the 2018 ICM criteria for periprosthetic joint infection were excluded. Postoperative antibiotic duration was the exposure of interest. Treatment failure, defined as infection-related re-revision, was the primary outcome; failure-free survival was the secondary outcome. Continuous variables were compared using the Mann-Whitney U test, and categorical variables were compared using chi-square or Fisher's exact tests. Factors associated with failure were examined using univariate logistic regression, and failure-free survival was assessed using Kaplan-Meier analysis with the log-rank test.Results Among 39 patients with one UPC, treatment failure occurred in 18%. Antibiotic courses longer than 21 days were associated with failure (OR 28.1). In the small subgroup with available data (n = 13), synovial biomarkers did not show a statistically significant difference between success and failure groups. Patients with one UPC had better failure-free survival than those with ≥ 2 UPCs.Conclusion The observed association between prolonged antibiotic therapy and treatment failure may reflect underlying infection severity rather than a causal effect of antibiotic duration. Individualized management is recommended for UPCs in aseptic revision arthroplasty.
SN - 1757-7853
SN - 1757-7861
ER -