Evaluating the Effect of Therapeutic Antibiotics in Prosthetic Joint Infections Culturing: A Narrative Review

Background and Aims: One of the important complications of knee and hip replacement arthroplasty is prosthetic joint infection (PJI), which is usually accompanied by negative culture that leads to severe consequences compared to positive ones. This study aims to evaluate the arbitrary use or mistreatment of antibiotics for therapeutic purposes before the final diagnosis of PJI and its effect on the culture result and the process of diagnosis and treatment of these infections. Method: A comprehensive search was performed in PubMed/MEDLINE, EMBASE, and Scopus using the following keywords: "PJI," "Antibiotic therapy," "False negative," and "Culture." We included clinical trials, cohort, case-control, and cross-sectional studies written in English. Results: Among the nine reviewed studies, all mentioned the therapeutic use of antibiotics as an important reason for negative culture results in PJI. Five studies examined the minimum recommended time for discontinuing antibiotic therapy, which varied from 4 days to 3 months. Four studies evaluated the type and dosage of antibiotics, and one study discussed the effect of antibiotics on tissue-infecting microorganisms. Conclusion: Using antibiotics for therapeutic purposes is the leading cause of false-negative cultures in joint prosthesis infections, which reduces the sensitivity of the culture in different ways, such as bacterial biofilm formation. Discontinuing antibiotics at least 2 weeks before sampling can help increase the sensitivity of the culturing. More studies should be done on other factors related to the effect of antibiotics on culture results, including the type of antibiotic and microorganism. With the available data, it can only be said that beta-lactams are the most common antibiotics used as therapeutic agents, leading to negative culture results. According to the Al-Mayahi study, therapeutic antibiotics increase the possibility of non-fermenting Gram-negative bacteria growth.