Preoperative antibiotic therapy decreased microbiologic culture yield
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Key takeaways:
- Preoperative antibiotic therapy significantly decreased operative culture yield in patients with native joint septic arthritis.
- Additional antibiotics and earlier initiation also led to decreases.
Preoperative antibiotic exposure led to a significant decrease in microbiologic yield of operative cultures among patients with native joint septic arthritis, researchers found.
These findings, which were initially reported at the Musculoskeletal Infection Society Annual Meeting, were recently published in Clinical Infectious Diseases.
“We noticed that there was an existing knowledge gap in the literature regarding the effect of preoperative antibiotic therapy on operative culture yield for native joint septic arthritis (NJSA) diagnosis and given this,” Ryan B. Khodadadi, MD, chief fellow in Mayo Clinic’s division of public health, infectious diseases, and occupational medicine, told Healio.
“We were hoping to learn more about the potential impact of antibiotic therapy on diagnostic accuracy for diagnosis of this condition,” he said.
The researchers retrospectively reviewed cases of NJSA among adult patients who underwent surgery at four Mayo Clinic facilities between 2012 and 2021. According to the study, they analyzed the effect of preoperative antibiotics on operative culture (OC) yield through a paired analysis of preoperative culture (POC) and OC results using logistic regression.
In total, 299 patients with NJSA affecting 321 joints were included in the study. The study showed that yield significantly decreased among the patients who received preoperative antibiotics, with 68% POC being positive before surgery and 57.1% OC remaining positive after antibiotic exposure (P < .001).
Among patients who did not receive preoperative antibiotics, there was a nonsignificant increase in culture positivity from 60.9% at POC to 67.4% at OC (P = .244).
Logistic regression analyses showed that preoperative antibiotic exposure was more likely to decrease positive OCs compared with nonexposure (OR = 2.12; 95% CI, 1.24-3.64). These patients also had a lower OC yield when given additional antibiotic doses (P < .001) and earlier antibiotic initiation (P < .001).
Based on these findings, Khodadadi said that this study emphasizes the importance of a “thoughtful stepwise approach” to antibiotic therapy and surgical management in NJSA, taking into account both the clinical urgency of early treatment and the potential impact on diagnostic accuracy.
“Given the significant decrease in microbiologic yield of operative cultures among patients exposed to antibiotics, we would recommend obtaining peripheral blood cultures and performing a diagnostic arthrocentesis prior to initiation of antibiotics to improve culture yield and inform the choice of definitive antibiotic therapy,” Khodadadi said. “From there, we would recommend administration of empiric preoperative antibiotic therapy followed by surgical joint evacuation.”
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