Diagnosis and Assessment
ÎÎBlood cultures for aerobic and anaerobic organisms should be
obtained if:
• fever is present
• there is an acute onset of symptoms
• the patient has a condition or suspected condition or concomitant infection or
pathogen (eg. S. aureus) that would make the presence of a bloodstream infection
more likely (B-III).
ÎÎImaging studies such as bone scans, leukocyte scans, MRI, CT and
PET scans should NOT be routinely used to diagnose PJI (B-III).
Intraoperative Diagnosis Of PJI
ÎÎIntraoperative histopathological examination of peri-prosthetic tissue
samples is a highly reliable diagnostic test provided that a pathologist
skilled in interpretation of periprosthetic tissue is available. It should
be performed at the time of revision prosthetic joint surgery, when
available, if:
• the presence of infection is in doubt based on the clinical suspicion of the surgeon
and
• the results will affect management, for example in deciding between revision
arthroplasty and two-stage exchange (B-III).
ÎÎAt least three and optimally five or six periprosthetic intraoperative
tissue samples or the explanted prosthesis itself should be submitted
for aerobic and anaerobic culture at the time of surgical debridement
or prosthesis removal to maximize the chance of obtaining a
microbiologic diagnosis (B-II).
ÎÎWhen possible (see above), withholding antimicrobial therapy for at
least two weeks prior to collecting intraoperative culture specimens
increases the yield of recovering an organism (A-II).
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