Articles | Volume 11, issue 4
https://doi.org/10.5194/jbji-11-413-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-11-413-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Original full-length article
| 
14 Jul 2026
Original full-length article |
| 14 Jul 2026
| 14 Jul 2026
Management and outcomes of culture-negative periprosthetic joint infection: a systematic review and meta-analysis
Farzad Pourghazi
Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
Seyed Mohammad Amin Alavi
Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 6135715753, Iran
Takahiro Matsuo
Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
Georges Baaklini
Faculty of medicine, Saint Joseph University, Beirut, Lebanon
Matthew P. Abdel
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
Aaron J. Tande
Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
Elie F. Berbari
CORRESPONDING AUTHOR
Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
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This work investigates periprosthetic joint infection (PJI) caused by rapidly growing mycobacteria (RGM) following total joint arthroplasty. Eight patients were identified as part of a retrospective review. The isolated RGM species included Mycobacterium abscessus (three cases), M. fortuitum (three cases), and one case each of M. immunogenum and M. mageritense. We provide novel insights into the successful treatment of PJIs caused by newly identified RGM (M. immunogenum and M. mageritense).
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J. Bone Joint Infect., 8, 143–149, https://doi.org/10.5194/jbji-8-143-2023, https://doi.org/10.5194/jbji-8-143-2023, 2023
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Physicians have difficulties interpreting the isolation of Cutibacterium acnes in the spine tissue. Here we provide the experience of our center about this topic, adding data that can help physicians in their choices. Our results show that some clinical, radiological, and microbiological features can help distinguish patients to treat or not to treat. Moreover, treatment with parenteral beta-lactams appears to be effective, but targeted oral therapy could be a valid alternative.
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This retrospective case-matched study evaluated males and females with staphylococcal PJI (periprosthetic joint infection) treated with two-stage exchange arthroplasty. We matched 156 males and females for age, type of staphylococcal infection, and joint involved. We compared clinical parameters related to presentation, treatment, and outcome. We did not find a statistically significant difference in outcome between males and females treated with the same surgical approach at our institution.
Matteo Passerini, Julian Maamari, Tarek Nayfeh, Leslie C. Hassett, Aaron J. Tande, Mohammad H. Murad, Zelalem Temesgen, and Elie F. Berbari
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Despite a growing interest in oral therapy for native vertebral osteomyelitis, there is no evidence to recommend oral or parenteral therapy. From our single-center experience combined with a systematic review and a meta-analysis of the available literature, there is insufficient evidence to conclude that there is a difference in proportion of failure and relapse between an early switch to oral antibiotics and prolonged parenteral therapy. Further studies are needed to increase the evidence.
Talha Riaz, Matthew Howard, Felix Diehn, Aaron Joseph Tande, Courtney Ross, Paul Huddleston, and Elie Berbari
J. Bone Joint Infect., 7, 213–219, https://doi.org/10.5194/jbji-7-213-2022, https://doi.org/10.5194/jbji-7-213-2022, 2022
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In this study, we prospectively enrolled patients with a suspected diagnosis of native vertebral osteomyelitis (NVO) undergoing image-guided needle aspiration of the intervertebral disc. Based on this pilot study, a high manual cell count or a high neutrophilic predominance from the disc aspirate was associated with the diagnosis of NVO.
Katharine Dobos, Gina A. Suh, Aaron J. Tande, and Shanthi Kappagoda
J. Bone Joint Infect., 7, 137–141, https://doi.org/10.5194/jbji-7-137-2022, https://doi.org/10.5194/jbji-7-137-2022, 2022
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This paper describes five cases of prosthetic joint infection (PJI) caused by Mycobacterium avium complex (MAC). Infections occurred in both immune competent and immunosuppressed patients. Interestingly, using the Musculoskeletal Infection Society diagnostic criteria for PJI may miss some cases of MAC PJI. Treatment courses and outcomes are described.
Julian Maamari, Aaron J. Tande, Felix Diehn, Don Bambino Geno Tai, and Elie F. Berbari
J. Bone Joint Infect., 7, 23–32, https://doi.org/10.5194/jbji-7-23-2022, https://doi.org/10.5194/jbji-7-23-2022, 2022
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The yearly incidence of native vertebral osteomyelitis (NVO) is increasing. In 2013 the prevalence of NVO in the USA was 5.4 cases per 100 000. Delays in the diagnosis of NVO remain common, in part due to the insidious nature of the infection and its related symptoms. The mean time between the onset of symptoms to diagnosis of NVO is 45.5 d. We herein review available and novel diagnostic modalities at the disposal of healthcare providers to reach an accurate and timely diagnosis of NVO.
Miao Xian Zhou, Elie F. Berbari, Cory G. Couch, Scott F. Gruwell, and Alan B. Carr
J. Bone Joint Infect., 6, 363–366, https://doi.org/10.5194/jbji-6-363-2021, https://doi.org/10.5194/jbji-6-363-2021, 2021
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This was written to outline Mayo Clinic guidelines on prophylactic antibiotics prior to invasive procedures in patients with prosthetic joints. There is an emphasis on maintaining optimal oral health to reduce the risk of infection to minimize the patient’s risk of PJI.
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Zhou, H., Yang, Y., Zhang, Y., Li, F., Shen, Y., Qin, L., and Huang, W.: Current status and perspectives of diagnosis and treatment of periprosthetic joint infection, Infect. Drug Resist., 17, 2417–2429, 2024.
Short summary
Culture-negative periprosthetic joint infection (CN-PJI) remains a diagnostic and therapeutic challenge. In this systematic review and meta-analysis of 27 studies (1399 patients), pooled success was 83.6 %, failure was 17.2 %, and mortality was 2.4 %. Outcomes were better with exchange arthroplasty than debridement, antimicrobials, and implant retention (DAIR). Antibiotic regimens were heterogeneous. Overall, CN-PJI may have favorable outcomes, but standardized prospective studies are needed.
Culture-negative periprosthetic joint infection (CN-PJI) remains a diagnostic and therapeutic...
