Preoperative antibiotic therapy may reduce culture yield in native joint septic arthritis
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Key takeaways:
- Preoperative antibiotic therapy may decrease operative culture yield in patients with native joint septic arthritis.
- Extra doses and early administration of antibiotics may also decrease culture yield.
Preoperative antibiotic exposure may decrease operative culture yield in patients with native joint septic arthritis, according to data presented at the Musculoskeletal Infection Society Annual Meeting.
“In conclusion, in patients with [native joint septic arthritis] NJSA, preoperative antibiotic exposure resulted in a significant decrease in operative culture yield as compared to patients in which antibiotic therapy was held prior to obtaining operative cultures,” Ryan B. Khodadadi, MD, said in his presentation here.
In a multicenter retrospective cohort study, Khodadadi and colleagues evaluated data from 299 patients (321 affected joints) with NJSA who underwent surgical intervention at four Mayo Clinic facilities between 2012 and 2021 to determine the effect of preoperative antibiotic therapy on culture yield in the diagnosis of NJSA.
“Included patients either received preoperative antibiotics or no antibiotics, defined as antibiotic exposure prior to surgical cultures,” Khodadadi said. “From there, patients in each group had a preoperative aspirate from which a culture was obtained with individuals in the exposure group receiving antibiotics prior to surgery, with operative cultures collected thereafter.”
Researchers found patients treated with preoperative antibiotic therapy (n=255) had a decrease in preoperative and operative culture yield. Khodadadi said 68% of cultures were positive before surgery and operative cultures remained positive in 57.1% of cases after preoperative antibiotic exposure.
Logistic regression analyses restricted to patients who received preoperative antibiotics showed an increasing number of doses of antibiotic therapy prior to surgery yielded a significant decrease in the predicted probability of a positive operative culture. Similarly, secondary analyses revealed an association between earlier and ongoing administration of antibiotic therapy with a lower rate of predicted probability of a positive culture yield, according to Khodadadi.
“The decision on whether to give preoperative antibiotic therapy in these cases is complicated and should take into consideration multiple factors, including the risk of concurrent bacteremia, which is estimated to be well over 30% in the literature, and that was similar in our study with our report,” Khodadadi said. “Additional considerations include the appreciable decrease in operative culture yield, which could obscure the microbiology of the infectious process and ultimately will complicate management decisions regarding definitive therapy when the patient is ready to dismiss.”
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Khodadadi RB, et al. Paper 1106. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 4-5, 2023; Salt Lake City (hybrid meeting).
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