A global survey of diagnostic practices in prosthetic joint infections

Prosthetic joint infections (PJIs) lead to significant morbidity, mortality and healthcare costs. A timely and accurate microbiological diagnosis is crucial for administering appropriate antimicrobial therapy. Periprosthetic tissue cultures are considered the 'gold standard' for microbiologically diagnosing PJIs. Though International guidelines provide some recommendations for achieving the aetiological diagnosis of PJI, many aspects remain unclear with local practices varying considerably. To better understand these practices, we conducted a global survey to evaluate microbiological diagnostic approaches for PJIs. One hundred and seven hospitals from 24 countries across six continents took part in the survey. Over half of the sites (51.4 %) were from Europe and the majority (79 %) were public hospitals. Nearly half of the sites (49.5 %) reported collecting 5-6 periprosthetic tissue samples for culture; however, 11 % collected fewer than 3 samples. Sonication on explanted joints were done in 46 (43 %) sites. It is noteworthy that 42 % of sites had a culture incubation period of 5 days or less, although 70 % of laboratories extended it under specific circumstances. Matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) was the most used method for bacterial identification (74.8 %), and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) was the preferred method for susceptibility testing (64.5 % of sites), though notable differences were observed between continents. The availability of polymerase chain reaction (PCR) was limited to 46 (43 %) sites. These global variations in diagnostic practices may contribute to discrepancies in the reported aetiology and percentage of culture-negative PJIs reported in the literature.