Culture of periprosthetic tissue in blood culture bottles for diagnosing periprosthetic joint infection

Abstract

Background: The purpose of this meta-analysis was to evaluate the diagnostic accuracy of periprosthetic tissue culture in blood culture bottles (BCB) for periprosthetic joint infection (PJI).

Methods: PubMed, Web of Science, and Embase were systematically searched for eligible studies evaluating the diagnostic performance of periprosthetic tissue culture in BCB for the diagnosis of PJI. The pooled data were analysed by Meta-Disc software.

Results: Four studies with a total of 1071 patients were included in this meta-analysis. The summarized estimates showed that periprosthetic tissue culture in BCB may be of great value in PJI diagnosis with a pooled sensitivity of 0.70 (95% confidence interval [CI]; 0.66-0.75), specificity of 0.97 (95% CI: 0.95-0.98); positive likelihood ratio (PLR) of 20.98 (95% CI: 11.52-38.2); negative likelihood ratio (NLR) of 0.28 (95% CI: 0.20-0.40); and diagnostic odds ratio (DOR) of 92.26 (95% CI: 43.93-193.78).

Conclusions: The present meta-analysis showed that periprosthetic tissue in BCB improves the results of microorganism cultures, with a sensitivity of 70% and a specificity of 97%. However, more large-scale, well-performed studies are needed to verify our findings.

Keywords: Blood culture bottles; Diagnosis; Meta-analysis; Periprosthetic joint infection; Periprosthetic tissue.

Fig. 1

Flowchart of the study inclusion process

Fig. 2

Quality of included studies according to QUADAS-2 guidelines

Fig. 3

Forest plot of sensitivity for periprosthetic tissue culture in BCB for the diagnosis of PJI

Fig. 4

Forest plot of specificity for periprosthetic tissue culture in BCB for the diagnosis of PJI

Fig. 5

Forest plots of positive likelihood ratio for periprosthetic tissue culture in BCB for the diagnosis of PJI

Fig. 6

Forest plots of negative likelihood ratio for periprosthetic tissue culture in BCB for the diagnosis of PJI

Fig. 7

Forest plots of diagnostic odds ratio for periprosthetic tissue culture in BCB for the diagnosis of PJI

Fig. 8

Summary receiver-operating characteristic (SROC) curve for periprosthetic tissue culture in BCB for the diagnosis of PJI. Red circles represent individual studies (see Figs. 3, 4, 5, 6, 7)