1. Effect of Preoperative Antibiotic Therapy on Operative Culture Yield for Diagnosis of Native Joint Septic Arthritis.
- Author
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Khodadadi RB, Damronglerd P, McHugh JW, El Zein S, Lahr BD, Yuan BJ, Abu Saleh OM, Suh GA, and Tande AJ
- Subjects
- Humans, Male, Female, Retrospective Studies, Middle Aged, Aged, Synovial Fluid microbiology, Preoperative Care, Adult, Arthrocentesis, Antibiotic Prophylaxis, Arthritis, Infectious microbiology, Arthritis, Infectious drug therapy, Arthritis, Infectious diagnosis, Anti-Bacterial Agents therapeutic use
- Abstract
Background: Native joint septic arthritis (NJSA) is definitively diagnosed by a positive Gram stain or culture, along with supportive clinical findings. Preoperative antibiotics are known to alter synovial fluid cell count, Gram stain, and culture results and are typically postponed until after arthrocentesis to optimize diagnostic accuracy. However, data on the impact of preoperative antibiotics on operative culture yield for NJSA diagnosis are limited., Methods: We retrospectively reviewed adult cases of NJSA who underwent surgery at Mayo Clinic facilities from 2012 to 2021 to analyze the effect of preoperative antibiotics on operative culture yield through a paired analysis of preoperative culture (POC) and operative culture (OC) results using logistic regression and generalized estimating equations., Results: Two hundred ninety-nine patients with NJSA affecting 321 joints were included. Among those receiving preoperative antibiotics, yield significantly decreased from 68.0% at POC to 57.1% at OC (P < .001). In contrast, for patients without preoperative antibiotics there was a non-significant increase in yield from 60.9% at POC to 67.4% at OC (P = .244). In a logistic regression model for paired data, preoperative antibiotic exposure was more likely to decrease OC yield compared to non-exposure (odds ratio [OR] = 2.12; 95% confidence interval [CI] = 1.24-3.64; P = .006). Within the preoperative antibiotic group, additional antibiotic doses and earlier antibiotic initiation were associated with lower OC yield., Conclusions: In patients with NJSA, preoperative antibiotic exposure resulted in a significant decrease in microbiologic yield of operative cultures as compared to patients in whom antibiotic therapy was held prior to obtaining operative cultures., Competing Interests: Potential conflicts of interest. B. J. Y. serves as a board/committee member for the American Academy of Orthopedic Surgeons (AAOS) and the Mid American Orthopaedic Association (MAOA). B. J. Y. also serves as paid consultant to Stryker and DePuy, a Johnson and Johnson Company. G. A. S. has a business relationship with and receives research support from Adaptive Phage Therapeutics, Inc. G. A. S. also receives research support from Phagelux. A. J. T. serves as a board/committee member of the Musculoskeletal Infection Society (MSIS) (unpaid role) and receives publishing royalties from Wolters Kluwer Health—Lippincott Williams & Wilkins. None of these entities have provided support for this current study. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
- Published
- 2024
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