Prosthetic joint infection diagnosed postoperatively by intraoperative culture

The purpose of this study was to assess the outcome of prosthetic joint infection initially diagnosed by multiple positive intraoperative cultures after revision arthroplasty and treated by strategies that include less than 6 weeks of intravenous antimicrobial therapy. Between January 1995 and December 1999, 16 of 509 (3%) episodes of prosthetic joint infection in 16 patients initially were diagnosed by positive intraoperative cultures after revision arthroplasty. Patients were followed up for a median of 1057 days (range, 731-1969 days). The median age of the patients was 65 years, and 65% of patients had revision total hip arthroplasty. Coagulase-negative staphylococci and Propionibacterium spp were the main pathogens identified. Intravenous antimicrobial therapy was used in 81% of patients and chronic oral suppression was used in 56% of patients. Three patients received no antimicrobial therapy. The median duration of intravenous antimicrobial therapy was 28 days (range, 2-42 days). The 5-year survival free of treatment failure for the 16 episodes was 89%. These results suggest a favorable outcome of prosthetic joint infections because of low virulence pathogens initially diagnosed as positive intraoperative cultures after revision arthroplasty with a variety of medical treatment strategies, including strategies that contain less than 6 weeks intravenous antimicrobial therapy. Level of Evidence: Prognostic study, Level IV-1 (case series).