Do Culture-Negative Periprosthetic Joint Infections Have a Worse Outcome Than Culture-Positive Periprosthetic Joint Infections? A Systematic Review and Meta-Analysis

Table 2

Data sheet for comparative analysis [15–22].

Author	Li H et al.	Choi HR et al.	Ibrahim MS et al.	Huang R et al.	Berbari EF et al.	Malekzadeh D et al.	Kim YH et al.	Kim YH et al.
Title	Two-stage revisions for culture-negative infected total knee arthroplasties: A five-year outcome in comparison with one-stage and two-stage revisions for culture-positive cases.	Periprosthetic joint infection with negative culture results: Clinical characteristics and treatment outcome.	Two-stage revision for the culture-negative infected total hip arthroplasty.	Culture-negative periprosthetic joint infection does not preclude infection control.	Culture-negative Prosthetic Joint Infection.	Prior Use of Antimicrobial Therapy is a Risk Factor for Culture-negative Prosthetic Joint Infection.	Comparison of infection control rates and clinical outcomes in culture-positive and culture-negative infected total-knee arthroplasty.	The outcome of infected total knee arthroplasty: culture-positive versus culture-negative.
Year	2017	2013	2017	2012	2007	2010	2015	2015
Country	Netherlands	United States	UK	United States	United States	United States	Korea	Korea
LoE	III	III	III	III	III	III	III	III
Study design	Retrospective	Retrospective	Prospective	Retrospective	Retrospective	Retrospective	Retrospective	Retrospective
Study Type	Case-Control study	Case-Control study	Case-Control study	Case-Control study	Cohort study	Case-Control study	Case-Control study	Case-Control study
Treatment interval	2003-2014	2000-2009	2007-2012	2000-2007	1990-1999	1985-2000	2001-2008	1991-2008
Total number of cases	129	175	-	295	897	1413	242	191
Prevalence of CN cases %	14.2	23	-	16.3	7	10.5	42.1	26.7
Hip %	-	50	100	43.8	45	50	-	-
Knee %	100	50	-	56.2	55	50	100	100
FU in months, median	55.6	52	60	47	36-60	56	127.2	127.2
Risk factors		-	(1) prior use of antibiotics; (2) referral from elsewhere; (3) age		(1) prior use of antibiotics (within 3 months)	(1) prior use of antibiotics (in 64%); (2) prolonged wound drainage after index arthroplasty (residual confounder)	-	-
Debridement n	-	11	-	12	12	18	56	28
1-stage n				3	5	8	-	-
2-stage n	18	23	50	33	34	56	46	23
Permanent resection n		-	-	-	8	34	-	-
Other therapy		6	-	-	1	19	-	-
Antibiotic treatment after diagnosis %	Vancomycin 33 Vancomycin + Ceftriaxone 33 Others 34	Vancomycin 70; Others 30	-	Vancomycin 81; Cephalosporins 10; Others 9	Cephalosporins 82; Vancomycin 12; Others 6	Cefazolin 69; Vancomycin 13; Others/None 18	Vancomycin 85; Others 15	Vancomycin 86; Others 14
Successful treatment in %	88,9	85	94	-	-	-	95	95
Overall infection free survival rate %; 1.) 3-year; 2.) 5-year	-	-	1.) -; 2.) 94	73	-	1.) -; 2.) 67	-	-
I&D infection free survival rate %; 1.) 3-year; 2.) 5-year	-	-	-	50	1.) -; 2.) 71	78	57	61
2-Stage infection free survival rate %; 1.) 3-year; 2.) 5-year	1.) 75; 2.) 95	-	-	58	1.) -; 2.) 94	1.) 87; 2.) 79	83	83
1-Stage infection free survival rate %; 1.) 3-year; 2.) 5-year	-	-	-	100	-	-	-	-
Resection arthroplasty infection free survival rate %; 1.) 3-year; 2.) 5-year	-	-	-	-	1.) 51	1.) 49; 2.) 43	-	-
Outcome	With combined or broad-spectrum antibiotics, two-stage revision showed comparable outcome in satisfaction rates, reinfections rates and cumulative survival rates at 5-year Follow-up with CP PJI patients.	The success rate of infection control was higher in the CN group, which suggests that CN may not necessarily be a negative prognostic factor for PJI.	-	The overall infection control rate was similar between CP and CN PJI cases (both 73%).	The outcome of CN PJI is similar to the outcome of PJI due to known pathogens.	The demographics and outcome of CP and CN PJI patients were similar (free of treatment failure at 2 years 79% and 75%).	The infection control rates and clinical outcomes were not different between CP and CN groups (overall infection control rates 90% and 95%).	Overall rates of infection control, successful treatment, and functional outcomes were not different between the CP and CN groups (overall infection control rates 90% and 95%).