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

Table 5

Antimicrobial treatment in CN PJI [23].

Microorganism	Antibiotic	Dose	Route
(red: difficult-to-treat)	(check pathogen susceptibility before)	(italic font: renal adjustment needed)
Culture-negative	Ampicillin/sulbactam	3 × 3 g	i.v.
	for 2 weeks, followed by:
	Rifampin + Levofloxacin	2 × 450 mg	p.o.
		2 × 500 mg	p.o.

Total duration of therapy: 12 weeks, usually 2 weeks intravenously, followed by oral route.
Laboratory testing 2x weekly: leukocytes, CRP, creatinine/eGFR, liver enzymes (AST/SGOT and ALT/SGPT). Dose-adjustment according to renal function and body weight (<40/> 100kg).
Penicillin allergy of NON-type 1 (e.g., skin rash): cefazolin (3 × 2 g i.v.). In case of anaphylaxis (= type 1 allergy such as Quincke’s edema, bronchospasm, and anaphylactic shock) or cephalosporin allergy, vancomycin (2 × 1 g i.v.) or daptomycin (1 × 8 mg/kg i.v.).
Ampicillin/sulbactam is equivalent to amoxicillin/clavulanic acid (3 × 2.2 g i.v.).
Rifampin is administered only after the new prosthesis is implanted. Add it already to intravenous treatment as soon as wounds are dry and drains removed; in patients aged >75 years, rifampin is reduced to 2 × 300 mg p.o.