Impact of Sequential Culture Results on Diagnosis and De-Escalation of the Antibiotic Regimen in Joint and Bone Infections

Surg Infect (Larchmt). Nov/Dec 2017;18(8):910-914. doi: 10.1089/sur.2017.106. Epub 2017 Oct 3.

Abstract

Background: According to existing guidelines, orthopedic specimens collected in joint and bone infections (JBI) in our institution are cultured on several media sets and incubated for two, seven, and 14 days. The optimal timing for de-escalation of the first-line antibiotic combination according to the culture results needs to be defined.

Methods: Single-center, retrospective analysis of all adult patients with a first documented episode of JBI between May 2012 and April 2013.

Results: Ninety patients were included, 51 males (57%), median age 58 y (range 18-87 y), with prosthesis infection in 62 cases (69%). Rapidly growing pathogens (Staphylococcus aureus [n = 36] and Enterobacteriaceae [n = 12]) usually were diagnosed within two days, whereas coagulase-negative staphylococci (n = 25) and Propionibacterium acnes (n = 13) generally were identified after seven days (p < 10-5). Positive culture results at day 2 fit with definitive microbiological diagnosis in 95% of cases, and prolonged incubation led to the identification of additional micro-organisms in only four of 76 patients (5%) with day-2-positive cultures. Conversely, for those with negative two-day culture (n = 14), the seven-day culture allowed identification of less virulent pathogens in eight cases (57%).

Conclusions: Our results suggest that, in JBI, de-escalation of the empirical antibiotic regimen can be based on micro-organisms identified on the two-day culture set. The impact of such a strategy on clinical outcomes, antibiotic consumption, and costs needs to be assessed in larger studies.

Keywords: antimicrobial stewardship; joint and bone infections; microbiological diagnosis; orthopedic device infections.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bacterial Typing Techniques
  • Bone and Bones / surgery*
  • Culture Media
  • Female
  • Humans
  • Joints / surgery*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Surgical Wound Infection / diagnosis
  • Surgical Wound Infection / drug therapy*
  • Surgical Wound Infection / microbiology
  • Young Adult

Substances

  • Culture Media