Culture-Negative Versus Culture-Positive Prosthetic Joint Infections: A Systematic Review and Meta-analysis

Rajesh Kumar; Himani Aggarwal; Lalit Pratap Singh

Article Details

Culture-Negative Versus Culture-Positive Prosthetic Joint Infections: A Systematic Review and Meta-analysis

Authors:

Rajesh Kumar | Himani Aggarwal | Lalit Pratap Singh

Publisher:

Journal of Contemporary Clinical Practice (JCCP)

Journal:

Journal of Contemporary Clinical Practice Vol.11 Issue 12, pp.757-763

Document Type:

Article

Publication Date:

12/2025

Document Language:

English

Document ID (Org No.):

2001613699

pISSN:

2457-7200

Keywords:

Abstract:

 Background: Culture-negative prosthetic joint infection (PJI) poses diagnostic and therapeutic challenges due to the absence of microbiological confirmation, often leading to broader empirical antibiotic use. The prognostic significance of culture-negative compared with culture-positive PJI remains uncertain. Objectives: To compare clinical characteristics, management strategies, and outcomes between culture-negative and culture-positive PJI. Methods: A systematic review and meta-analysis of studies published between January 2000 and December 2024 was conducted following PRISMA guidelines. Eighteen comparative studies comprising 6,214 patients were included, of whom 1,182 (19.0%) had culture-negative and 5,032 (81.0%) had culture-positive PJI. Pooled risk ratios (RR) with 95% confidence intervals (CI) were generated using a random-effects model. Results: Prior antimicrobial exposure was significantly more frequent in culture-negative PJI (58% vs 24%; RR 2.41; 95% CI 1.88–3.09). Surgical strategies were comparable between groups, including DAIR (34% vs 31%) and two-stage revision (49% vs 52%). Overall treatment success was similar (74.3% vs 75.6%; RR 0.98; 95% CI 0.93–1.03). Two-stage revision success did not differ significantly (82.1% vs 84.5%; RR 0.96; 95% CI 0.88–1.05), and failure after DAIR was comparable (29.6% vs 27.4%; RR 1.08; 95% CI 0.91–1.27). Culture-negative cases more frequently received empirical broad-spectrum antibiotics (72% vs 18%), although treatment duration was similar. Conclusion: Culture-negative PJI is strongly associated with prior antibiotic exposure but demonstrates comparable surgical and clinical outcomes to culture-positive PJI when managed with standard evidence-based treatment pathways. Improving diagnostic yield and promoting antimicrobial stewardship remain key priorities.

Article Details

Culture-Negative Versus Culture-Positive Prosthetic Joint Infections: A Systematic Review and Meta-analysis

Authors:

Rajesh Kumar | Himani Aggarwal | Lalit Pratap Singh

Publisher:

Journal of Contemporary Clinical Practice (JCCP)

Journal:

Journal of Contemporary Clinical Practice Vol.11 Issue 12, pp.757-763

Document Type:

Article

Publication Date:

12/2025

Document Language:

English

Document ID (Org No.):

2001613699

pISSN:

2457-7200

culture-negative pji

prosthetic joint infection

arthroplasty

dair

revision surgery

meta-analysis

Issues

Article Details

Culture-Negative Versus Culture-Positive Prosthetic Joint Infections: A Systematic Review and Meta-analysis

Authors: Rajesh Kumar | Himani Aggarwal | Lalit Pratap Singh

Publisher: Journal of Contemporary Clinical Practice (JCCP)

Journal: Journal of Contemporary Clinical Practice Vol.11 Issue 12, pp.757-763

Document Type: Article

Publication Date: 12/2025

Document Language: English

Document ID (Org No.): 2001613699

pISSN: 2457-7200

culture-negative pji

prosthetic joint infection

arthroplasty

dair

revision surgery

meta-analysis

Issues

Authors:

Rajesh Kumar | Himani Aggarwal | Lalit Pratap Singh

Publisher:

Journal of Contemporary Clinical Practice (JCCP)

Journal:

Journal of Contemporary Clinical Practice Vol.11 Issue 12, pp.757-763

Document Type:

Article

Publication Date:

12/2025

Document Language:

English

Document ID (Org No.):

2001613699

pISSN:

2457-7200