Brief CommunicationNew Definition for Periprosthetic Joint Infection
Section snippets
Definition of PJI
Based on the proposed criteria, a definite PJI exists when:
- (1)
there is a sinus tract communicating with the prosthesis; or
- (2)
a pathogen is isolated by culture from 2 or more separate tissue or fluid samples obtained from the affected prosthetic joint; or
- (3)
when 4 of the following 6 criteria exist:
- (a)
elevated serum erythrocyte sedimentation rate and serum C-reactive protein (CRP) concentration,
- (b)
elevated synovial white blood cell count,
- (c)
elevated synovial polymorphonuclear percentage (PMN%),
- (d)
presence of
Microbiologic Testing
It is imperative that tissue for culture be obtained from representative periprosthetic tissue or fluid. To limit the risk of contamination, each sample should be taken with separate, sterile instruments. The definition of phenotypically identical organisms should be based on phenotypic similarities and in vitro antimicrobial susceptibility testing because confirmation of genetic identity is not routinely performed on clinical isolates. It is recommended that at least 3 and no more than 5
Acknowledgments
We would like to thank Sandra Berrios-Torres, MD; Ryan Fagan, MD, MPH; and Teresa C. Horan from the Centers for Disease Control and Prevention for their valuable input and assistance in the process of reaching these criteria.
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Cited by (0)
The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.09.026.
Parts of this article have been reprinted from Clin Orthop Relat Res, vol 469, 2011, p. 2992, New definition for periprosthetic joint infection: from the workgroup of the Musculoskeletal Infection by Parvizi J, Zmistowski B, Berbar, EF, et al, © The Association of Bone and Joint Surgeons 2011, with kind permission of Springer Science and Business Media.