Abstract
Introduction With an increase in the number of total joint arthroplasties, the count of prosthetic
joint infections (PJIs) is also increasing and has become a nightmare for an orthopaedic
surgeon. Microbiological diagnosis is important for administering definitive antimicrobial
treatment. Negative culture reports hamper patient management and prolonged incubation
periods have increased the culture yield but at the risk of culture contamination
in conventional microbiology settings. Thus, we aimed to optimize the best incubation
time for culture and the aerobic bacterial profile of PJIs.
Material and Methods Over a year, samples from clinically suspected PJI patients were collected and processed
for culture using standard techniques. The samples were incubated for up to 10 days
with daily subculturing on to solid media. The bacterial isolates were identified
and antibiotic susceptibility was performed.
Results Out of 200 patients, 105 were included in the study and samples were collected in
triplicate. In 70 cases culture was positive and 35 were culture negative PJIs. Mean
incubation days to culture positivity was 3.6 days with 97.14% culture positivity
seen by the seventh day of incubation. Twenty-four percent methicillin-resistant Staphylococcus aureus, and more than 50% extended spectrum β lactamase producing Klebsiella pneumoniae and Escherichia coli were isolated.
Discussion Culture positivity in PJIs provides definitive evidence of infection and guides the
treatment. Increasing the incubation times can help in maximizing the culture yield,
and we found that 97.14% pathogens grew within 7 days of incubation. Prolonging it
further would not provide an added advantage especially in a resource-constraint setting.
Keywords
prosthesis - infections - culture - prolonged incubation -
Staphylococcus aureus
