How Does the Time from Intraoperative Culture Harvest to Incubation Impact Culture Positivity in Orthopaedic Surgeries? A Case–Control Study

Background: Orthopaedic infections require accurate microbiological diagnosis for effective treatment. This study aimed to evaluate the impact of an accelerated protocol for culture harvesting and incubation on culture positivity rates in orthopaedic surgeries, comparing it to the traditional protocol. Methods: A single-center, 1:1 matched case–control study was conducted at the Rubin Institute for Advanced Orthopaedics. Patients undergoing orthopaedic surgery with suspected infections were divided into two groups (108 patients): accelerated protocol (June–November 2024) and traditional protocol (January–June 2024). The time from operating room (OR) to incubation was significantly shorter in the accelerated group (89 min vs. 245 min, p < 0.001). Culture positivity rates and microorganism profiles were compared. The temporal dynamics of culture positivity were evaluated using Kaplan–Meier analysis across the entire cohort. A logistic regression analysis was carried out between the time from OR to incubation and culture positivity. Results: The accelerated protocol group had significantly higher culture positivity rates (70.4%) compared to the traditional group (48.1%) (p = 0.027). Microbial profiles were similar between groups. The probability of culture positivity across the entire cohort decreased by 6% for every 10-min delay after 100 min from OR. Regression analysis showed a significant inverse association between time and culture positivity (β = −0.005, p = 0.016). Conclusions: The accelerated protocol significantly improved culture positivity rates without compromising diagnostic performance. Reducing the time from sample collection to incubation enhances pathogen detection across all pathogen types, potentially improving outcomes in orthopaedic infection management.