Optimal Incubation Time for Synovial-Fluid Cultures in Acute and Chronic Periprosthetic Joint Infection: A Retrospective Cohort Study

Optimal Incubation Time for Synovial-Fluid Cultures in Acute and Chronic Periprosthetic Joint Infection: A Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Optimal Incubation Time for Synovial-Fluid Cultures in Acute and Chronic Periprosthetic Joint Infection: A Retrospective Cohort Study Shoujie Huo, Yicheng Li, Xiaobin Guo, Xiaogang Zhang, Li Cao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8751356/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Standard 14-day incubation protocols for periprosthetic joint infections (PJIs) lack specificity.The optimal culture duration for distinct acute and chronic PJI remains undefined. This study aimed to define the microbial time-to-positivity (TTP) and distribution in different PJI categories to evaluate the feasibility of a stratified culture strategy. Methods This retrospective study analysed the medical records of patients from 1 June 2016 to 1 July 2024. Patients who met the Musculoskeletal Infection Society (MSIS) criteria and had positive intraoperative synovial-fluid cultures were classified into Early acute PJI, Late acute PJI, and Late chronic PJI based on clinical symptoms. The microbial spectrum and TTP of synovial-fluid specimens were recorded. The microbial profiles and detection rates of different PJI subtypes were compared across different time stages. Results We included 181 patients (mean age 65 years). Among them, 41 cases were Early acute PJI; 35 cases, Late acute PJI; and 105 Late chronic PJI. All pathogens recovered within 12 days. In Early acute PJI and Late acute PJI, 90.3 and 94.3% of pathogens, respectively, grew by day 7, whereas 96.2% of Late chronic PJI isolates required up to 10 days. The rate of new microbial detection decreased sharply after day 5 of incubation. After 7 days, delayed microbial growth was predominantly seen in the Late chronic PJI cohort. Previous antibiotic exposure did not significantly affect the growth of microorganisms in acute PJI (OR = 2.52, 95% CI 0.43–14.65; P = 0.31). Conclusion Previous use of antibiotics prolongs the incubation time of microorganisms but has a limited effect on the incubation time of microorganisms in acute PJI. A 7-day incubation period is sufficient to reliably detect pathogen in acute PJI. For chronic PJI, considering the delayed growth of some pathogen, at least 10 days of culture are required. Periprosthetic joint infection Culture Incubation time Arthroplasty Bacteria Figures Figure 1 Figure 2 Figure 3 Introduction Periprosthetic joint infection (PJI) is a leading cause of revision arthroplasty, requiring surgical intervention with removal of infected tissues and components, and reimplantation of a new prosthesis [ 1 , 2 ]. Accurate diagnosis of PJI is the prerequisite for treatment. Although the 2018 International Consensus Meeting (ICM) addressed the number of specimens necessary for PJI diagnosis, it did not specify the recommended duration for pathogen culture [ 3 ]. Furthermore, timely microbiological diagnosis is critical for optimal clinical outcomes, as it guides the physician in formulating a targeted antibiotic regimen [ 3 ]. Low-virulence pathogens such as coagulase-negative staphylococci, characterised by slow growth, predominate in PJI, and extending culture duration, significantly increases the pathogen culture positivity rate [ 4 – 6 ]. Consequently, extending the culture incubation time to 14–21 days has become routine practice at some centres [ 4 – 7 ]. However, recent evidence presents conflicting findings, demonstrating that prolonged incubation does not enhance microorganism identification but may instead increase the risk of false-positive results due to contaminating bacteria [8–11]. Theoretically, pathogens causing acute PJI typically exhibit rapid proliferation, facilitating swift identification through standard culture methods. Conversely, organisms in chronic PJI often exist in a quiescent state within established biofilms. These pathogens are shed intermittently, demanding prolonged culture for detection [ 4 , 10 – 12 ]. Despite these recognized differences in microbial behaviour, no consensus on culture duration tailored to PJI subtypes has been established, and evidence-based guidelines are lacking. Therefore, this study aimed to compare the distribution of microbial species in the intraoperative synovial fluid of patients with acute and chronic PJI at different latent periods, aiming to determine the optimal incubation time for both acute and chronic PJI. We hypothesised that acute PJI demonstrates a shorter culture incubation period than chronic PJI, and that a prolonged 14-day incubation may not be required for the diagnosis of many acute infections. Material and methods Study population Institutional Review Board approval of this study was obtained. This single-centre retrospective study included patients with PJI who underwent revision joint surgery between June 2016 and June 2024, and who had positive intraoperative joint fluid cultures. All cases were diagnosed according to the MSIS criteria (Appendix). Patients were stratified into three PJI subtypes based on the timing and nature of symptom onset: Early acute PJI, with infectious signs emerging ≤ 3 months postoperatively; Late acute PJI, with acute symptom onset > 3 months postoperatively and a diagnosis made 3 months postoperatively [ 13 – 15 ]. A total of 181 patients met the inclusion criteria, comprising 87 hip and 94 knee PJIs. The cohort was stratified into 41 Early acute PJI, 35 Late acute PJI, and 105 Late chronic PJI cases (Table 1 ). A retrospective review of electronic medical records was conducted to extract patient data. Demographic variables included age, sex, and body mass index (BMI). Clinical variables included the affected joint (hip or knee), laterality, and history of antibiotic therapy prior to sample collection. Microbiological data were also collected, including the number of culture-positive specimens, the specific microorganisms isolated, and the time-to-positivity (TTP) for each positive culture. Any discrepant or ambiguous results were re-evaluated by a senior microbiologist to resolve inconsistencies; unresolved cases were excluded from the analysis. Table 1 Patient demographic characteristics Characteristic Total (N = 181) Early acute(n = 41) Late acute (n = 35) Late chronic(n = 105) P -value Age (years) 65.5 (51-71.75) 69.48 ± 8.78 65.5 (60–74) 63.5 (52–71) P = 0.003 a Sex (n, %) P = 0.189 b Women 100 (55.2%) 23 (56.1%) 24 (68.6%) 53 (50.5%) Men 81 (44.8%) 18 (43.9%) 11 (31.4%) 52 (49.5%) BMI (kg/m 2 ) 25 (22–28) 25(20.25-28) 26 ± 4.16 25.14 ± 4.04 P = 0.51 a Laterality (n, %) P = 0.629 b Left 90 (49.7%) 23 (56.1%) 16(45.7%) 51 (48.6%) Right 91 (50.3%) 18 (43.9%) 19(54.3%) 54 (51.4%) Operative treated joint (n, %) P = 0.855 b Hip 87 (48.1%) 19 (46.3%) 16(45.7%) 52 (49.5%) Knee 94 (51.9%) 22 (53.7%) 19(54.3%) 53 (50.5%) ASA (n, %) P = 0.023 c I 2 (1.1%) 2 (5.7%) II 99 (53.7%) 18 (43.9%) 15 (42.9%) 66 (62.9%) III 77 (42.5%) 22 (53.7%) 18 (51.4%) 37 (35.2%) IV 3 (1.7%) 1 (2.4%) 2 (1.9%) Sinus Tract (n, %) P = 0.529 b Yes 68 (37.6%) 18 (43.9%) 11 (31.4%) 39 (37.1%) No 113 (62.4%) 23 (56.1%) 24 (68.6%) 66 (62.9%) Antibiotic therapy, ≤ 4 weeks before admission 62 (34.3%) 19 (46.3%) 16 (45.7%) 27 (25.7%) P = 0.017 BMI, body mass index; ASA, American Society of Anesthesiologists; TTP, time to positive; Early acute PJI, within 3 months after the index arthroplasty; Late acute PJI, infection within 4 weeks from occurrence of symptoms (but > 3 months after the index arthroplasty); Late chronic PJI, > 4 weeks after symptom onset (but > 3 months after the index arthroplasty). a Kruskal–Wallis H test; b Chi-square test; c Fisher–Freeman–Halton exact test. Culture sampling technique During revision arthroplasty, synovial fluid was aseptically aspirated and directly inoculated into both aerobic and anaerobic blood culture bottles (Bact/ALERT FA Plus and FN Plus; bioMérieux). The inoculated bottles were immediately transported to the microbiology laboratory and loaded into a BACT/ALERT 3D 120 automated culture system (bioMérieux) within 2 hours of collection. Bottles were incubated for a total of 14 days or until flagged positive by the system. Upon a positive signal, an aliquot was immediately removed for Gram staining and was sub-cultured onto both Columbia blood agar and MacConkey agar plates. The agar plates were incubated at 35°C in an atmosphere of 5–10% CO 2 and were inspected for growth at 24 and 48 hours. Bacterial colonies from the agar plates were identified using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) with a VITEK MS system (bioMérieux, Marcy-l'Étoile, France). Antimicrobial susceptibility testing was subsequently performed and interpreted according to the prevailing Clinical and Laboratory Standards Institute guidelines. Cultures demonstrating no growth on subculture plates after 48 hours of incubation were finalised as negative. Prophylactic antibiotics were administered before all surgical incisions [ 16 , 17 ]. Data analyses Statistical analysis was performed using IBM SPSS Statistics (version 29, Chicago, IL) software. Continuous data are presented as mean and standard deviation or median and interquartile range (IQR). Categorical data are expressed as numbers and percentages. Non-parametric tests were used to compare continuous and categorical variables among groups. The Kruskal–Wallis test was used for comparisons involving more than two groups. The Chi-squared test, Fisher’s exact test, or Fisher-Freeman-Halton exact test was used to compare categorical variables. To investigate the association between prior antibiotic therapy and delayed microbial growth, we performed a univariate logistic regression analysis. A P-value < 0.05 was considered statistically significant. Results Overall pathogen distribution and time to detection in PJI Overall, among the 181 pathogenic bacteria, 88.7% were detected within 7 days, and all were detected within 12 days (Fig. 3 ). Coagulase-negative staphylococci (CoNS, n = 39) was the most common isolated pathogen, followed by methicillin-resistant Staphylococcus epidermidis (MRSE, n = 34) and methicillin-sensitive staphylococcus aureus (MSSA, n = 32) (Table 2 ). There was no significant difference in the distribution of CoNS (p = 0.45). MSSA and slow-growing bacteria was the most common in Late chronic PJI (p < 0.05) (Table VI). All Enterobacteriaceae , Streptococcus , and Enterococcus were detected within 5 days (Table 2 , Fig. 1 ). A total of five cases of fungus were detected. Table 2 Overall distribution of major pathogens in all PJI positive cultures and their detection across different time intervals Pathogen No. of Positive Cultures (No. of Strains Identified) from Synovial Fluid/Incubation Period Days D0–3 (87, 48.07%) D4–5 (59, 32.60%) D6–7 (15, 8.29%) D8–10 (15, 8.29%) D11–12 (5, 2.76%) TOTAL (181, 100%) MSSA 18 10 1 1 2 32 CoNS* 20 14 2 2 1 39 MRSE 15 8 7 3 1 34 Enterobacteriaceae 10 3 13 Klebsiella 2 1 3 Enterococcus 3 4 7 Streptococcus 3 8 1 12 Brucella 3 3 2 1 9 Fungus 1 2 1 1 5 Corynebacterium 1 1 1 1 4 MRSA 5 3 1 9 Pseudomonas 3 1 1 5 Baumanii 1 1 Bacillus 2 2 Burkholderia 1 1 Cutibacterium acnes 1 2 3 Kocuria varians 1 1 Nocardia 1 1 MSSA, methicillin-sensitive Staphylococcus aureus; CoNS, coagulase-negative Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis. *CoNS (Staphylococcus epidermidis, Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus caprae, Staphylococcus capitis, Staphylococcus simulans, Staphylococcus haemolyticus) Pathogen distribution at different incubation time intervals Early period (days 0–3) In the early incubation period, 48% of microorganisms were detected. In Early acute PJI, 56% of the pathogenic bacteria were detected, with CoNS (n = 8), MRSE (n = 5), and Enterobacteriaceae (n = 5) being the predominant types. In the Late acute PJI cohort, most organisms were fast-growing MSSA (n = 7) and Enterobacteriaceae (n = 3). The microorganisms in the Late chronic PJI cohort were dominated by common species such as con (n = 10), MSSA (n = 10), and MRSE (n = 8) (Table 3 , 4 , 5 ; Fig. 2 , 3 ). Table 3 Microbial distribution across time intervals by Early acute PJI Pathogen No. of Positive Cultures (No. of Strains Identified) from Synovial Fluid/Incubation Period Days D0–3 (23, 56.10%) D4–5 (10, 24.39%) D6–7 (4, 9.76%) D8–10 (3, 7.32%) D11–12 (1, 2.44%) TOTAL (41, 100%) MSSA 1 1 CoNS* 8 1 9 MRSE 5 3 2 1 1 12 Enterobacteriaceae 5 5 Klebsiella 1 1 Enterococcus 1 1 2 Streptococcus 1 1 Brucella 1 1 Fungus 1 1 2 Corynebacterium 1 1 MRSA 2 1 1 4 Burkholderia 1 1 Nocardia 1 1 MSSA, methicillin- sensitive Staphylococcus aureus; CoNS, coagulase-negative Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis. *CoNS (Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus simulans, Staphylococcus haemolyticus) Table 4 Microbial distribution across time intervals by Late acute PJI Pathogen No. of Positive Cultures (No. of Strains Identified) from Synovial Fluid/Incubation Period Days D0–3 (19, 54.29%) D4–5 (11, 31.43%) D6–7 (3, 8.57%) D8–10 (2, 5.71%) D11–12 TOTAL (35, 100%) MSSA 7 1 8 CoNS* 2 2 1 5 MRSE 2 1 1 1 5 Enterobacteriaceae 3 3 6 Klebsiella 1 1 Enterococcus 1 1 Streptococcus 2 3 5 Brucella 2 2 Fungus 1 1 Baumanii 1 1 MSSA, methicillin-sensitive Staphylococcus aureus; CoNS, coagulase-negative Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis. *CoNS (Staphylococcus epidermidis, Staphylococcus lugdunensis) Table 5 Microbial distribution across time intervals by Late chronic PJI Pathogen No. of Positive Cultures (No. of Strains Identified) from Synovial Fluid/Incubation Period Days D0-3 (45,42.86%) D4-5 (38,36.19%) D6-7 (8,7.62%) D8-10 (10,9.52%) D11-12 (4,3.81%) TOTAL (105, 100%) MSSA 10 9 1 1 2 23 CoNS* 10 12 1 1 1 25 MRSE 8 4 4 1 17 Enterobacteriaceae 2 2 Klebsiella 1 1 Enterococcus 1 3 4 Streptococcus 1 4 1 6 Brucella 3 2 1 6 Fungus 1 1 2 Corynebacterium 1 1 1 3 MRSA 3 2 5 Pseudomonas 3 1 1 5 Bacillus 2 2 Cutibacterium acnes 1 2 3 Kocuria varians 1 1 MSSA, methicillin-sensitive Staphylococcus aureus; CoNS, coagulase-negative Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis. *CoNS (Staphylococcus epidermidis, Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus caprae, Staphylococcus capitis) Table 6 The distribution differences of the main microorganisms Pathogen Early acute PJI (N = 41) Late acute PJI (N = 35) Late chronic PJI (N = 105) χ² value P-value MSSA 1 (2.4%) 8 (22.9%) 23 (21.90%) 8.16 0.01 MRSA 4 (9.76%) 0 (0.0%) 5 (4.8%) 3.82 0.15 CoNS 9 (22.0%) 5 (14.3%) 25 (23.8%) 1.58 0.45 MRSE 12 (29.3%) 5 (14.3%) 17 (16.2%) 5.97 0.05 Enterobacter 5 (12.2%) 6 (17.1%) 2 (1.9%) 11.23 0.003 Streptococcus 1 (2.4%) 5 (14.3%) 6 (5.7%) 5.92 0.05 P. aeruginosa 0 (0.0%) 0 (0.0%) 5 (4.8%) 6.89 0.03 Slow-growing bacteria* 2 (4.9%) 0 (0.0%) 9 (8.6%) 8.83 0.01 Other Pathogens 7 (17.07%) 6 (17.1%) 13 (12.38%) 1.03 0.60 MSSA, methicillin- sensitive Staphylococcus aureus; CoNS, coagulase-negative; Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis. *Cutibacterium acnes, Corynebacterium, Nocardia, Bacillus, Kocuria varians Middle period (days 4–7) During this period, 40.9% of microorganisms were detected. The detection rate of microorganisms significantly decreased after 5 days (32.6% to 8.29%, χ 2 = 32.88, P < 0.001). In Early acute PJI, MRSE (n = 5) remained the predominant microorganism. In Late acute PJI, Enterobacteriaceae (n = 3) and Streptococcus (n = 3) were the main microorganisms detected. In Late chronic PJI, CoNS (n = 13), MSSA (n = 10), and MRSE (n = 8) remained the main pathogenic bacteria detected (Table 3 , 4 , 5 ; Fig. 2 , 3 ). Late-stage period (days 8–12) During this period, 11.04% of the pathogenic bacteria were detected, 70% of these pathogenic bacteria originated from Late chronic PJI, and most were slow-growing bacteria. Acute PJI was detected in only six cases (3 MRSE, 1 CoNS, 1 Corynebacterium, 1 Nocardia) (Table 3 , 4 , 5 ; Fig. 2 , 3 ). Microbial abundance changes In acute PJI (Figs. 2 A, 2 B), species richness was highest during the first 5 days of incubation. After day 5 the profile narrowed rapidly; by days 10–12 almost all cultures yielded a single organism, indicating most of them grew during the early stage. Chronic PJI displayed a different pattern (Fig. 2 C). Diversity declined up to day 7, then rebounded between day 8 and day 10, before falling again after day 11. Compared with acute PJI, the differences were significant (χ 2 = 7.23, P = 0.03, Fisher’s exact). This rebound suggests that several organisms begin to proliferate only with prolonged incubation. Previous antibiotic treatment A significant association was found between preoperative antibiotic therapy and the type of PJI (p = 0.017). Patients presenting with acute PJI were substantially more likely to have received recent antibiotics (56.5%) compared to those with chronic PJI (43.5%). Furthermore, the use of antibiotics prior to admission was found to be significantly associated with the delay in microbial growth (OR = 2.64, 95% confidence interval [CI]: 1.03–6.76; P = 0.044). However, after conducting subgroup analysis, no significant findings were observed in acute PJI (OR = 2.52, 95% CI: 0.43–14.65; P = 0.305) (Table 7 ). Table 7 Univariate logistic regression analysis of prior antibiotic therapy as a risk factor for delayed microbial growth (> 7 days) Antibiotic therapy, ≤ 4 weeks before admission Univariate logistic analysis β SE Z P- value OR (95%CI) PJI NO 1.00 YES 0.97 0.48 2.02 0.044 2.64 (1.03 ~ 6.76) Acute PJI (Early & Late acute) NO 1.00 YES 0.92 0.90 1.03 0.305 2.52 (0.43 ~ 14.65) Chronic PJI NO 1.00 YES 1.27 0.59 2.14 0.032 3.55 (1.11 ~ 11.32) SE, standard error; OR, odds ratio; CI, confidence interval; PJI, periprosthetic joint infection; Discussion The distinct microbial profiles observed within the first 72 hours of culture support distinct pathogenic pathways of each PJI subtype. Early acute PJI is usually caused by direct intraoperative contamination, and its microbial spectrum is typically dominated by commensal bacteria on the skin, especially CoNS [ 1 , 2 ]. In contrast, Late acute PJI, which is primarily due to hematogenous dissemination, exhibits a broader microbial spectrum with a significantly higher proportion of Staphylococcus aureus and Streptococcus spp, consistent with reports identifying them as common pathogens in hematogenous PJI [ 18 – 20 ]. These pathogens rapidly proliferate in the synovial fluid in a planktonic state, leading to high bacterial loads and severe acute inflammatory responses in the host. In Late chronic PJI, although Staphylococcus aureus and CoNS still dominate, multiple factors such as biofilm‑mediated protection and host immune factors jointly contribute to the complex phenomenon of bacterial species diversity [ 1 , 2 , 21 , 22 ]. Our findings, based on the dominant, rapidly growing isolates recovered within the first 3 days of culture, provide robust support for this framework, implicating these organisms as the primary causative pathogens in their respective PJI subtypes. Clinical decisions on incubation duration for PJI should be tailored to both the suspected pathogen and the infection subtype. This study reaffirms that a 7-day incubation period sufficiently detects most microorganisms in synovial fluid, consistent with previous reports [11]. We further observed that gram-negative bacilli, particularly Enterobacteriaceae , consistently recovered within 5 days [ 24 , 25 ]. This may be attributed to their unique cell wall structure, which facilitate rapid proliferation in the host environment, thereby enabling earlier crossing of the diagnostic threshold [ 23 ]. In contrast, fungal detection presents greater complexity. While optimal incubation times range from 7 to 14 days [ 25 , 26 ], previous studies lacked PJI subtype stratification. Our analysis provides crucial clarification on this point. In acute PJI, fungal pathogens were detected within 5 days, aligning with Morreel et al. [ 15 ]. In contrast, all instances in our cohort in which extended incubation (> 5 days) was required for fungal recovery occurred in patients with chronic PJI. This pattern is consistent with the typically insidious process of chronic fungal infections. For patients with chronic PJI who have risk factors, a high degree of suspicion for fungal aetiology should be maintained, especially considering that approximately 20% of fungal PJI are polymicrobial [ 27 – 29 ]. We identified days 6–7 as a critical inflection point in microbial culture. During this window, the yield of new pathogens declined markedly (from 32.6% to 8.3%), coinciding with a shift from highly virulent, fast-growers, to low-virulence, slow-growing organisms. Importantly, this transition manifested differently across PJI subtypes. In acute PJI, the microbial profile had already stabilised before day 7, with minimal new pathogen emergence thereafter. In contrast, chronic PJI demonstrated continued microbial detection beyond this timepoint, with a substantial proportion of isolates emerging after day 7. While several studies have questioned the cost-effectiveness of extending incubation beyond 7 days [ 8 , 30 ], others have shown that late-growing isolates, particularly in chronic infections, may alter antimicrobial therapy selection [ 4 , 31 ]. We, therefore, recommend selective extension of the incubation period for suspected chronic PJI, where late-growing microorganisms may significantly impact treatment decisions. Prior antibiotic therapy was associated with a delay in microbial detection only in chronic infections, even though it was administered more frequently in acute cases, where no comparable delay was observed. Prior antibiotic therapy can reduce the sensitivity of microbial culture [ 32 ]. However, Esteban et al. did not observe such a difference in their research [ 30 ]. We observed that the growth of chronic PJI pathogenic bacteria is more susceptible to the influence of prior antibiotic therapy. Although the proportion of prior antibiotic therapy in acute PJI is higher, the effect is not significant. There are several potential explanations for this difference. First, acute PJI is usually treated with a short course of therapy, which can partially inhibit the planktonic bacteria, but due to the vigorous metabolism of the bacterial community, the bacteria can still rapidly multiply and reach the detection threshold. Second, in chronic PJI, bacteria are encased within a mature biofilm, leading to a dormant state. This enables them to be resistant to antibiotics [ 1 , 2 , 21 , 22 ]. Therefore, even with long-term antibiotic treatments in the past, these pathogens could not be eradicated [ 21 – 23 ]. Antibiotics eliminate the active planktonic bacteria, while the dormant subgroups persist [ 35 , 36 ]. When cultured outside the body, these “persistent” cells require a longer incubation period before they can be detected [ 33 , 34 , 36 ]. Therefore, growth beyond day 7 may reflect the dormant pathogens within the biofilm; the antibiotic exposure itself cannot fully explain this phenomenon. Since our study only included synovial-fluid samples, further validation of the conclusions is still needed in terms of sample types. Our study has some limitations. As a retrospective analysis, our study is subject to selection and information bias. Furthermore, the absence of a prospective 7-day control group precludes direct comparison of diagnostic yields, necessitating validation through randomised controlled trials. Finally, although phenotypic classification criteria for PJI have been established, in clinical practice, the boundary between acute and chronic infections is sometimes blurred and overlapping cases may exist. Future research should integrate molecular diagnostics with traditional culture to enhance detection efficiency while reducing time to diagnosis. In conclusion, based on synovial fluid cultures, an incubation period of 7 days is sufficient to detect most pathogenic bacteria in acute PJI, whereas the incubation period for chronic PJI should be extended to at least 10 days. The previous use of antibiotics did not affect the microbial incubation time for acute PJI. This finding needs to be confirmed in a larger prospective cohort. Whether these time ranges are applicable to the peri-prosthetic tissue and the ultrasound fluid requires further study. Declarations Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of First Affiliated Hospital of Xinjiang Medical University ( 220120-15 ).The requirement for obtaining written informed consent from participants was waived by this Institutional Review Board (IRB) due to the retrospective nature of the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Funding This study was supported by the Science and Technology Innovation Team Project of Xinjiang Uygur Autonomous Region Science and Technology Department (2023TSYCTD0014), Major Special Projects of the Science and Technology Plan of Xinjiang Uygur Autonomous Region (2022A03011), and the Xinjiang Medical University Major Scientific Research Achievement Cultivation Project (XYD2024ZC01), 2024. Author contributions Shoujie Huo: Writing - original draft, Investigation, Data curation, Methodology. Yicheng Li: Investigation, Validation, Data curation, Writing -original draft. Xiaobin Guo: Data curation, Methodology, Investigation. Xiaogang Zhang:Data curation, Methodology, Investigation. Li Cao: Writing - review & editing, Conceptualization, Resources, Supervision. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Acknowledgements This study was supported by the Science and Technology Innovation Team Project of Xinjiang Uygur Autonomous Region Science and Technology Department (2023TSYCTD0014), Major Special Projects of the Science and Technology Plan of Xinjiang Uygur Autonomous Region (2022A03011), and the Xinjiang Medical University Major Scientific Research Achievement Cultivation Project (XYD2024ZC01), 2024. References Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27:302–45. Patel R. Periprosthetic Joint Infection. N Engl J Med. 2023;388:251–62. Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: an evidence-based and validated criteria. J Arthroplasty. Schäfer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis. 2008;47:1403–9. Drago L, De Vecchi E, Cappelletti L, Vassena C, Toscano M, Bortolin M, Mattina R, Romanò CL. Prolonging culture to 15 days improves bacterial detection in bone and joint infections. Eur J Clin Microbiol Infect Dis. 2015;34:1809–13. Costerton JW, Cheng KJ, Geesey GG, Ladd TI, Nickel JC, Dasgupta M, Marrie TJ. Bacterial biofilms in nature and disease. Annu Rev Microbiol. 1987;41:435–64. Butler-Wu SM, Burns EM, Pottinger PS, Magaret AS, Rakeman JL, Matsen FA, Cookson III BT. Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection. J Clin Microbiol. 2011;49:2490–5. Klement MR, Cunningham DJ, Wooster BM, Wellman SS, Bolognesi MP, Green CL, Garrigues GE. Comparing Standard Versus Extended Culture Duration in Acute Hip and Knee Periprosthetic Joint Infection. J Am Acad Orthop Surg. 2019;27(9):e437–43. Tarabichi S, Goh GS, Zanna L, Qadiri QS, Baker CM, Gehrke T, Citak M, Parvizi J. Time to Positivity of Cultures Obtained for Periprosthetic Joint Infection. J Bone Joint Surg Am. 2023;105(2):107–12. Talsma DT, Ploegmakers JJW, Jutte PC, Kampinga G, WouthuyzenBakker M, Birlutiu RM, Stoica CI, Russu O, Cismasiu RS, Birlutiu V. Positivity Trends of Bacterial Cultures from Cases of Acute and Chronic Periprosthetic Joint Infections. J Clin Med. 2022;11(8):2238. Wood TK, Knabel SJ, Kwan BW. Bacterial persister cell formation and dormancy. Appl Environ Microbiol. 2013;79(23):7116–21. Beldman M, Löwik C, Soriano A, Albiach L, Zijlstra WP, Knobben BAS, Jutte P, Sousa R, Carvalho A, Goswami K, Parvizi J, Belden KA, Wouthuy zen-Bakker M. If, when, and how to use rifampin in acute staphylococcal periprosthetic joint infections, a multicentre observational study. Clin Infect Dis. 2021;73:1634–41. Kramer TS, Soriano A, Tedeschi S, Chen AF, Tattevin P, Senneville E, Gomez-Junyent J, Birlutiu V, Petersdorf S, de Brito VD, Gonzalez IS, Belden KA, Wouthuyzen-Bakker M. Should We Use Rifampicin in Periprosthetic Joint Infections Caused by Staphylococci When the Implant Has Been Exchanged? A Multicenter Observational Cohort Study. Open Forum Infect Dis. 2024;11(3):ofae075. Morreel ERL, van Dessel HA, Geurts J, Savelkoul PHM, van Loo IHM. Prolonged incubation time unwarranted for acute periprosthetic joint infections. J Clin Microbiol. 2025;63(2):e0114324. Ghanem E, Parvizi J, Clohisy J, Burnett S, Sharkey PF, Barrack R. Perioperative antibiotics should not be withheld in proven cases of periprosthetic infection. Clin Orthop Relat Res. 2007;461(461):44–7. Anagnostopoulos A, Bossard DA, Ledergerber B, Zingg PO, Zinkernagel AS, Gerber C, Achermann Y. Perioperative antibiotic prophylaxis has no effect on time to positivity and proportion of positive samples: a cohort study of 64 Cutibacterium acnes bone and joint infections. J Clin Microbiol. 2018;56(2):e01576-17-17. Murdoch DR, Roberts SA, Fowler VG Jr, Shah MA, Taylor SL, Morris AJ, Corey GR. Infection of orthopedic prostheses after Staphylococcus aureus bacteremia. Clin Infect Dis. 2001;32:647–9. Sendi P, Banderet F, Graber P, Zimmerli W. Periprosthetic joint infection following Staphylococcus aureus bacteremia. J Infect. 2011;63:17–22. Konigsberg BS, Valle CJ, Ting NT, Qiu F, Sporer SM. 3 September 2013, posting date. Acute hematogenous infection following total hip and knee arthroplasty. J. Arthroplasty [Epub ahead of print.]. Høiby N, Ciofu O, Johansen HK, Song ZJ, Moser C, Jensen PØ, Molin S, Givskov M, Tolker-Nielsen T, Bjarnsholt T. The clinical impact of bacterial biofilms. Int J Oral Sci. 2011;3(2):55–65. Arciola CR, Campoccia D, Montanaro L. Implant infections: adhesion, biofilm formation and immune evasion. Nat Rev Microbiol. 2018;16(7):397–409. Ruhal R, Kataria R. Biofilm patterns in gram-positive and gram-negative bacteria. Microbiol Res. 2021;251:126829. Cobo J, Miguel LG, Euba G, Rodriguez D, Garcia-Lechuz JM, Riera M, Falgueras L, Palomino J, Benito N, del Toro MD, Pigrau C, Ariza J. Early prosthetic joint infection: outcomes with debridement and implant retention followed by antibiotic therapy. Clin Microbiol Infect. 2011;17:1632–7. Baez C, MacDonell R, Tishad A, Prieto HA, Miley EN, Deen JT, Gray CF, Parvataneni HK, Pulido L. Comparison of Five-Day vs. Fourteen-Day Incubation of Cultures for Diagnosis of Periprosthetic Joint Infection in Hip Arthroplasty. J Clin Med. 2024;13(15):4467. Wu B, Lin Y, Su J, Lin L, Yu Z, Zhang C, Fang X, Huang Z, Zhang W. Extending the culture duration could not improve the culture positivity rate and clinical outcomes of periprosthetic joint infection. Front Cell Infect Microbiol. 2025;15:1551862. Azzam K, Parvizi J, Jungkind D, Hanssen A, Fehring T, Springer B, Bozic K, Della Valle C, Pulido L, Barrack R. Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience. J Bone Joint Surg Am. 2009;91(Suppl 6):142–9. Sidhu MS, Cooper G, Jenkins N, Jeys L, Parry M, Stevenson JD. Prosthetic fungal infections: poor prognosis with bacterial co-infection. Bone Joint J. 2019;101–B(5):582–8. Sambri A, Zunarelli R, Fiore M, Bortoli M, Paolucci A, Filippini M, Zamparini E, Tedeschi S, Viale P, De Paolis M. Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature. Microorganisms. 2022;11(1):84. Esteban J, Alvarez-Alvarez B, Blanco A, Fernández-Roblas R, Gadea I, Garcia-Cañete J, Sandoval E, Valdazo M. Prolonged incubation time does not increase sensitivity for the diagnosis of implant-related infection using samples prepared by sonication of the implants. Bone Joint J. 2013;95–B(7):1001–6. Deroche L, Bémer P, Valentin AS, Jolivet-Gougeon A, Tandé D, Héry-Arnaud G, Lemarié C, Kempf M, Bret L, Burucoa C, Corvec S, Plouzeau C. The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections. J Clin Med. 2019;8(12):2113. Trampuz A, Piper KE, Jacobson MJ, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357:654–63. Gazendam A, Wood TJ, Tushinski D, Bali K. Diagnosing Periprosthetic Joint Infection: a Scoping Review. Curr Rev Musculoskelet Med. 2022;15(3):219–29. Fisher C, Patel R. Rifampin, Rifapentine, and Rifabutin Are Active against Intracellular Periprosthetic Joint Infection-Associated Staphylococcus epidermidis. Antimicrob Agents Chemother. 2021;65(2):e01275–20. Steixner SJM, Spiegel C, Dammerer D, Wurm A, Nogler M, Coraça-Huber DC. Influence of Nutrient Media Compared to Human Synovial Fluid on the Antibiotic Susceptibility and Biofilm Gene Expression of Coagulase-Negative Staphylococci In Vitro. Antibiot (Basel). 2021;10(7):790. Hamad C, Chowdhry M, Sindeldecker D, Bernthal NM, Stoodley P, McPherson EJ. Adaptive antimicrobial resistance, a description of microbial variants, and their relevance to periprosthetic joint infection. Bone Joint J. 2022;104–B(5):575–80. Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 13 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviewers agreed at journal 27 Feb, 2026 Reviewers invited by journal 24 Feb, 2026 Editor assigned by journal 23 Feb, 2026 Editor invited by journal 03 Feb, 2026 Submission checks completed at journal 03 Feb, 2026 First submitted to journal 03 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8751356","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":597762574,"identity":"733f3332-87f8-43c2-ae3d-6a400fa3aa97","order_by":0,"name":"Shoujie Huo","email":"","orcid":"","institution":"First Affiliated Hospital of Xinjiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shoujie","middleName":"","lastName":"Huo","suffix":""},{"id":597762578,"identity":"d632eaf6-c4f7-4850-b991-53bec94ccc3a","order_by":1,"name":"Yicheng Li","email":"","orcid":"","institution":"First Affiliated Hospital of Xinjiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yicheng","middleName":"","lastName":"Li","suffix":""},{"id":597762583,"identity":"3f73c20f-38d0-4b93-ade9-615ecaa3c2e1","order_by":2,"name":"Xiaobin Guo","email":"","orcid":"","institution":"First Affiliated Hospital of Xinjiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaobin","middleName":"","lastName":"Guo","suffix":""},{"id":597762584,"identity":"5b9cda7f-b172-4834-9e81-b12c97281670","order_by":3,"name":"Xiaogang Zhang","email":"","orcid":"","institution":"First Affiliated Hospital of Xinjiang Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaogang","middleName":"","lastName":"Zhang","suffix":""},{"id":597762585,"identity":"6b40fa41-ed8e-4c0f-a899-4b1af7be0826","order_by":4,"name":"Li Cao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAqklEQVRIiWNgGAWjYFCCMyDChoGNVC1pJGnhARGHSdBgcPDswccFFeft+aSbHzD8qNhGWItkw7lk4xlnbie2yRwzYOw5c5uwFn6GM2bSvG23E9gkEgyYGduI0MIG1vLvnD2bRPoH4rRAbGk4wNgmkUOkLWC/8BxLTgRqKThIlF8MbgBDjKfGzl5+RvrGBz8qiNDCIHEAwT6ASxEq4G8gTt0oGAWjYBSMYAAAR4A4ZJW+lbkAAAAASUVORK5CYII=","orcid":"","institution":"First Affiliated Hospital of Xinjiang Medical University","correspondingAuthor":true,"prefix":"","firstName":"Li","middleName":"","lastName":"Cao","suffix":""}],"badges":[],"createdAt":"2026-01-31 16:38:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8751356/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8751356/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103728751,"identity":"b868210f-08a8-4c6d-a392-b569a09e48db","added_by":"auto","created_at":"2026-03-02 08:43:53","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":254646,"visible":true,"origin":"","legend":"\u003cp\u003eStacked bar chart depicting the percentage composition of various pathogens over the five cultivation periods. MSSA, methicillin- sensitive Staphylococcus aureus; CoNS, coagulase-negative; Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8751356/v1/82aa0035c4cd681be41d89fe.jpeg"},{"id":103728743,"identity":"4d96a562-4da4-4f16-882a-2526615fd91d","added_by":"auto","created_at":"2026-03-02 08:43:52","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":73727,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA.\u003c/strong\u003e Stacked bar chart depicting the percentage composition of various pathogens during the five culture periods in the Early acute PJI. \u003cstrong\u003eB.\u003c/strong\u003e Stacked bar chart depicting the percentage composition of various pathogens during the four culture periods in the Late acute PJI. \u003cstrong\u003eC. \u003c/strong\u003eStacked bar chart depicting the percentage composition of various pathogens during the five culture periods of Late chronic PJI. MSSA, methicillin- sensitive Staphylococcus aureus; CoNS, coagulase-negative; Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8751356/v1/5696498b13243167f73cfa91.jpeg"},{"id":103728754,"identity":"296bb9de-b375-4cf8-935d-ba1dac9c9a46","added_by":"auto","created_at":"2026-03-02 08:43:53","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":88095,"visible":true,"origin":"","legend":"\u003cp\u003eLine graph showing the percentage of positive cultures over five time periods. Different coloured lines represent different classifications.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8751356/v1/ae599e0dc17ac5883fd3aaa9.jpeg"},{"id":104400206,"identity":"6fd7a949-2c0d-4add-a1d9-d82240f13048","added_by":"auto","created_at":"2026-03-11 12:09:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1873593,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8751356/v1/0f1fd151-0088-4c3b-9d9d-901ef5f644ed.pdf"},{"id":103728745,"identity":"630f18ff-9766-4180-99f3-837f4398ed2c","added_by":"auto","created_at":"2026-03-02 08:43:53","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":11538,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-8751356/v1/f41fc77d9df5d92e3923e650.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Optimal Incubation Time for Synovial-Fluid Cultures in Acute and Chronic Periprosthetic Joint Infection: A Retrospective Cohort Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePeriprosthetic joint infection (PJI) is a leading cause of revision arthroplasty, requiring surgical intervention with removal of infected tissues and components, and reimplantation of a new prosthesis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Accurate diagnosis of PJI is the prerequisite for treatment. Although the 2018 International Consensus Meeting (ICM) addressed the number of specimens necessary for PJI diagnosis, it did not specify the recommended duration for pathogen culture [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Furthermore, timely microbiological diagnosis is critical for optimal clinical outcomes, as it guides the physician in formulating a targeted antibiotic regimen [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLow-virulence pathogens such as coagulase-negative staphylococci, characterised by slow growth, predominate in PJI, and extending culture duration, significantly increases the pathogen culture positivity rate [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Consequently, extending the culture incubation time to 14\u0026ndash;21 days has become routine practice at some centres [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, recent evidence presents conflicting findings, demonstrating that prolonged incubation does not enhance microorganism identification but may instead increase the risk of false-positive results due to contaminating bacteria [8\u0026ndash;11].\u003c/p\u003e \u003cp\u003eTheoretically, pathogens causing acute PJI typically exhibit rapid proliferation, facilitating swift identification through standard culture methods. Conversely, organisms in chronic PJI often exist in a quiescent state within established biofilms. These pathogens are shed intermittently, demanding prolonged culture for detection [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Despite these recognized differences in microbial behaviour, no consensus on culture duration tailored to PJI subtypes has been established, and evidence-based guidelines are lacking.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to compare the distribution of microbial species in the intraoperative synovial fluid of patients with acute and chronic PJI at different latent periods, aiming to determine the optimal incubation time for both acute and chronic PJI. We hypothesised that acute PJI demonstrates a shorter culture incubation period than chronic PJI, and that a prolonged 14-day incubation may not be required for the diagnosis of many acute infections.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003e Institutional Review Board approval of this study was obtained. This single-centre retrospective study included patients with PJI who underwent revision joint surgery between June 2016 and June 2024, and who had positive intraoperative joint fluid cultures. All cases were diagnosed according to the MSIS criteria (Appendix). Patients were stratified into three PJI subtypes based on the timing and nature of symptom onset: Early acute PJI, with infectious signs emerging\u0026thinsp;\u0026le;\u0026thinsp;3 months postoperatively; Late acute PJI, with acute symptom onset\u0026thinsp;\u0026gt;\u0026thinsp;3 months postoperatively and a diagnosis made\u0026thinsp;\u0026lt;\u0026thinsp;4 weeks from initial symptoms; and Late chronic PJI, with an insidious onset or symptoms persisting for \u0026ge;\u0026thinsp;4 weeks, occurring\u0026thinsp;\u0026gt;\u0026thinsp;3 months postoperatively [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA total of 181 patients met the inclusion criteria, comprising 87 hip and 94 knee PJIs. The cohort was stratified into 41 Early acute PJI, 35 Late acute PJI, and 105 Late chronic PJI cases (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A retrospective review of electronic medical records was conducted to extract patient data. Demographic variables included age, sex, and body mass index (BMI). Clinical variables included the affected joint (hip or knee), laterality, and history of antibiotic therapy prior to sample collection. Microbiological data were also collected, including the number of culture-positive specimens, the specific microorganisms isolated, and the time-to-positivity (TTP) for each positive culture. Any discrepant or ambiguous results were re-evaluated by a senior microbiologist to resolve inconsistencies; unresolved cases were excluded from the analysis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient demographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;181)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEarly acute(n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLate acute (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLate chronic(n\u0026thinsp;=\u0026thinsp;105)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.5 (51-71.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.48\u0026thinsp;\u0026plusmn;\u0026thinsp;8.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.5 (60\u0026ndash;74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e63.5 (52\u0026ndash;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.189\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (55.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (56.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24 (68.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53 (50.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (44.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (43.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 (31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52 (49.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (22\u0026ndash;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(20.25-28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u0026thinsp;\u0026plusmn;\u0026thinsp;4.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.51\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaterality (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.629\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (49.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (56.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16(45.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e51 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (50.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (43.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19(54.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e54 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperative treated joint (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.855\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87 (48.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16(45.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52 (49.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (51.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (53.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19(54.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53 (50.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (53.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (43.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e66 (62.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (42.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (53.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37 (35.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSinus Tract (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.529\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (37.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (43.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 (31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39 (37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113 (62.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (56.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24 (68.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e66 (62.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntibiotic therapy, \u0026le;\u0026thinsp;4 weeks before admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16 (45.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27 (25.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eBMI, body mass index; ASA, American Society of Anesthesiologists; TTP, time to positive; Early acute PJI, within 3 months after the index arthroplasty; Late acute PJI, infection within 4 weeks from occurrence of symptoms (but \u0026gt;\u0026thinsp;3 months after the index arthroplasty); Late chronic PJI, \u0026gt;\u0026thinsp;4 weeks after symptom onset (but \u0026gt;\u0026thinsp;3 months after the index arthroplasty). \u003csup\u003ea\u003c/sup\u003eKruskal\u0026ndash;Wallis H test; \u003csup\u003eb\u003c/sup\u003eChi-square test; \u003csup\u003ec\u003c/sup\u003eFisher\u0026ndash;Freeman\u0026ndash;Halton exact test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCulture sampling technique\u003c/h3\u003e\n\u003cp\u003eDuring revision arthroplasty, synovial fluid was aseptically aspirated and directly inoculated into both aerobic and anaerobic blood culture bottles (Bact/ALERT FA Plus and FN Plus; bioM\u0026eacute;rieux). The inoculated bottles were immediately transported to the microbiology laboratory and loaded into a BACT/ALERT 3D 120 automated culture system (bioM\u0026eacute;rieux) within 2 hours of collection. Bottles were incubated for a total of 14 days or until flagged positive by the system. Upon a positive signal, an aliquot was immediately removed for Gram staining and was sub-cultured onto both Columbia blood agar and MacConkey agar plates. The agar plates were incubated at 35\u0026deg;C in an atmosphere of 5\u0026ndash;10% CO\u003csub\u003e2\u003c/sub\u003e and were inspected for growth at 24 and 48 hours. Bacterial colonies from the agar plates were identified using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) with a VITEK MS system (bioM\u0026eacute;rieux, Marcy-l'\u0026Eacute;toile, France). Antimicrobial susceptibility testing was subsequently performed and interpreted according to the prevailing Clinical and Laboratory Standards Institute guidelines. Cultures demonstrating no growth on subculture plates after 48 hours of incubation were finalised as negative. Prophylactic antibiotics were administered before all surgical incisions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eData analyses\u003c/h3\u003e\n\u003cp\u003eStatistical analysis was performed using IBM SPSS Statistics (version 29, Chicago, IL) software. Continuous data are presented as mean and standard deviation or median and interquartile range (IQR). Categorical data are expressed as numbers and percentages. Non-parametric tests were used to compare continuous and categorical variables among groups. The Kruskal\u0026ndash;Wallis test was used for comparisons involving more than two groups. The Chi-squared test, Fisher\u0026rsquo;s exact test, or Fisher-Freeman-Halton exact test was used to compare categorical variables. To investigate the association between prior antibiotic therapy and delayed microbial growth, we performed a univariate logistic regression analysis. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eOverall pathogen distribution and time to detection in PJI\u003c/h2\u003e \u003cp\u003eOverall, among the 181 pathogenic bacteria, 88.7% were detected within 7 days, and all were detected within 12 days (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Coagulase-negative staphylococci (CoNS, n\u0026thinsp;=\u0026thinsp;39) was the most common isolated pathogen, followed by methicillin-resistant \u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e (MRSE, n\u0026thinsp;=\u0026thinsp;34) and methicillin-sensitive \u003cem\u003estaphylococcus aureus\u003c/em\u003e (MSSA, n\u0026thinsp;=\u0026thinsp;32) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). There was no significant difference in the distribution of CoNS (p\u0026thinsp;=\u0026thinsp;0.45). MSSA and slow-growing bacteria was the most common in Late chronic PJI (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table VI). All \u003cem\u003eEnterobacteriaceae\u003c/em\u003e, \u003cem\u003eStreptococcus\u003c/em\u003e, and Enterococcus were detected within 5 days (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A total of five cases of fungus were detected.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverall distribution of major pathogens in all PJI positive cultures and their detection across different time intervals\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePathogen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNo. of Positive Cultures (No. of Strains Identified) from Synovial Fluid/Incubation Period Days\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eD0\u0026ndash;3\u003c/p\u003e \u003cp\u003e(87, 48.07%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eD4\u0026ndash;5\u003c/p\u003e \u003cp\u003e(59, 32.60%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eD6\u0026ndash;7\u003c/p\u003e \u003cp\u003e(15, 8.29%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eD8\u0026ndash;10\u003c/p\u003e \u003cp\u003e(15, 8.29%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eD11\u0026ndash;12\u003c/p\u003e \u003cp\u003e(5, 2.76%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTOTAL\u003c/p\u003e \u003cp\u003e(181, 100%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMSSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoNS*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnterobacteriaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKlebsiella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnterococcus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStreptococcus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrucella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFungus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorynebacterium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePseudomonas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaumanii\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBacillus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurkholderia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCutibacterium acnes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKocuria varians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNocardia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eMSSA, methicillin-sensitive Staphylococcus aureus; CoNS, coagulase-negative Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis. *CoNS (Staphylococcus epidermidis, Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus caprae, Staphylococcus capitis, Staphylococcus simulans, Staphylococcus haemolyticus)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePathogen distribution at different incubation time intervals\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eEarly period (days 0\u0026ndash;3)\u003c/h2\u003e \u003cp\u003eIn the early incubation period, 48% of microorganisms were detected. In Early acute PJI, 56% of the pathogenic bacteria were detected, with CoNS (n\u0026thinsp;=\u0026thinsp;8), MRSE (n\u0026thinsp;=\u0026thinsp;5), and Enterobacteriaceae (n\u0026thinsp;=\u0026thinsp;5) being the predominant types. In the Late acute PJI cohort, most organisms were fast-growing MSSA (n\u0026thinsp;=\u0026thinsp;7) and Enterobacteriaceae (n\u0026thinsp;=\u0026thinsp;3). The microorganisms in the Late chronic PJI cohort were dominated by common species such as con (n\u0026thinsp;=\u0026thinsp;10), MSSA (n\u0026thinsp;=\u0026thinsp;10), and MRSE (n\u0026thinsp;=\u0026thinsp;8) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e,\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e,\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMicrobial distribution across time intervals by Early acute PJI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePathogen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNo. of Positive Cultures (No. of Strains Identified) from Synovial Fluid/Incubation Period Days\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eD0\u0026ndash;3\u003c/p\u003e \u003cp\u003e(23, 56.10%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eD4\u0026ndash;5\u003c/p\u003e \u003cp\u003e(10, 24.39%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eD6\u0026ndash;7\u003c/p\u003e \u003cp\u003e(4, 9.76%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eD8\u0026ndash;10\u003c/p\u003e \u003cp\u003e(3, 7.32%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eD11\u0026ndash;12\u003c/p\u003e \u003cp\u003e(1, 2.44%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTOTAL\u003c/p\u003e \u003cp\u003e(41, 100%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMSSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoNS*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnterobacteriaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKlebsiella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnterococcus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStreptococcus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrucella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFungus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorynebacterium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBurkholderia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNocardia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eMSSA, methicillin- sensitive Staphylococcus aureus; CoNS, coagulase-negative Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*CoNS (Staphylococcus epidermidis, Staphylococcus hominis, Staphylococcus simulans, Staphylococcus haemolyticus)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMicrobial distribution across time intervals by Late acute PJI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePathogen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNo. of Positive Cultures (No. of Strains Identified) from Synovial Fluid/Incubation Period Days\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eD0\u0026ndash;3\u003c/p\u003e \u003cp\u003e(19, 54.29%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eD4\u0026ndash;5\u003c/p\u003e \u003cp\u003e(11, 31.43%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eD6\u0026ndash;7\u003c/p\u003e \u003cp\u003e(3, 8.57%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eD8\u0026ndash;10\u003c/p\u003e \u003cp\u003e(2, 5.71%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eD11\u0026ndash;12\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTOTAL\u003c/p\u003e \u003cp\u003e(35, 100%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMSSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoNS*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnterobacteriaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKlebsiella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnterococcus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStreptococcus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrucella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFungus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaumanii\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eMSSA, methicillin-sensitive Staphylococcus aureus; CoNS, coagulase-negative Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*CoNS (Staphylococcus epidermidis, Staphylococcus lugdunensis)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMicrobial distribution across time intervals by Late chronic PJI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePathogen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eNo. of Positive Cultures (No. of Strains Identified) from Synovial Fluid/Incubation Period Days\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eD0-3\u003c/p\u003e \u003cp\u003e(45,42.86%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eD4-5\u003c/p\u003e \u003cp\u003e(38,36.19%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eD6-7\u003c/p\u003e \u003cp\u003e(8,7.62%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eD8-10\u003c/p\u003e \u003cp\u003e(10,9.52%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eD11-12\u003c/p\u003e \u003cp\u003e(4,3.81%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTOTAL\u003c/p\u003e \u003cp\u003e(105, 100%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMSSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoNS*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnterobacteriaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKlebsiella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnterococcus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStreptococcus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrucella\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFungus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorynebacterium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePseudomonas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBacillus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCutibacterium acnes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKocuria varians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eMSSA, methicillin-sensitive Staphylococcus aureus; CoNS, coagulase-negative Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; MRSE,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003emethicillin-resistant Staphylococcus epidermidis.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*CoNS (Staphylococcus epidermidis, Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus caprae, Staphylococcus capitis)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eThe distribution differences of the main microorganisms\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathogen\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEarly acute PJI\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLate acute PJI\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLate chronic PJI (N\u0026thinsp;=\u0026thinsp;105)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMSSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (21.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (9.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoNS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMRSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (29.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17 (16.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnterobacter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (12.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStreptococcus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP. aeruginosa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlow-growing bacteria*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Pathogens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (17.07%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13 (12.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eMSSA, methicillin- sensitive Staphylococcus aureus; CoNS, coagulase-negative; Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis. *Cutibacterium acnes, Corynebacterium, Nocardia, Bacillus, Kocuria varians\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eMiddle period (days 4–7)\u003c/h3\u003e\n\u003cp\u003eDuring this period, 40.9% of microorganisms were detected. The detection rate of microorganisms significantly decreased after 5 days (32.6% to 8.29%, χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;32.88, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In Early acute PJI, MRSE (n\u0026thinsp;=\u0026thinsp;5) remained the predominant microorganism. In Late acute PJI, Enterobacteriaceae (n\u0026thinsp;=\u0026thinsp;3) and Streptococcus (n\u0026thinsp;=\u0026thinsp;3) were the main microorganisms detected. In Late chronic PJI, CoNS (n\u0026thinsp;=\u0026thinsp;13), MSSA (n\u0026thinsp;=\u0026thinsp;10), and MRSE (n\u0026thinsp;=\u0026thinsp;8) remained the main pathogenic bacteria detected (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e,\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e,\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLate-stage period (days 8\u0026ndash;12)\u003c/h2\u003e \u003cp\u003eDuring this period, 11.04% of the pathogenic bacteria were detected, 70% of these pathogenic bacteria originated from Late chronic PJI, and most were slow-growing bacteria. Acute PJI was detected in only six cases (3 MRSE, 1 CoNS, 1 Corynebacterium, 1 Nocardia) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e,\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e,\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMicrobial abundance changes\u003c/h2\u003e \u003cp\u003eIn acute PJI (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eA, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eB), species richness was highest during the first 5 days of incubation. After day 5 the profile narrowed rapidly; by days 10\u0026ndash;12 almost all cultures yielded a single organism, indicating most of them grew during the early stage.\u003c/p\u003e \u003cp\u003eChronic PJI displayed a different pattern (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eC). Diversity declined up to day 7, then rebounded between day 8 and day 10, before falling again after day 11. Compared with acute PJI, the differences were significant (χ\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7.23, P\u0026thinsp;=\u0026thinsp;0.03, Fisher\u0026rsquo;s exact). This rebound suggests that several organisms begin to proliferate only with prolonged incubation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePrevious antibiotic treatment\u003c/h2\u003e \u003cp\u003eA significant association was found between preoperative antibiotic therapy and the type of PJI (p\u0026thinsp;=\u0026thinsp;0.017). Patients presenting with acute PJI were substantially more likely to have received recent antibiotics (56.5%) compared to those with chronic PJI (43.5%). Furthermore, the use of antibiotics prior to admission was found to be significantly associated with the delay in microbial growth (OR\u0026thinsp;=\u0026thinsp;2.64, 95% confidence interval [CI]: 1.03\u0026ndash;6.76; P\u0026thinsp;=\u0026thinsp;0.044). However, after conducting subgroup analysis, no significant findings were observed in acute PJI (OR\u0026thinsp;=\u0026thinsp;2.52, 95% CI: 0.43\u0026ndash;14.65; P\u0026thinsp;=\u0026thinsp;0.305) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate logistic regression analysis of prior antibiotic therapy as a risk factor for delayed microbial growth (\u0026gt;\u0026thinsp;7 days)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAntibiotic therapy, \u0026le;\u0026thinsp;4 weeks before admission\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eUnivariate logistic analysis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP- value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePJI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.044\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.64 (1.03\u0026thinsp;~\u0026thinsp;6.76)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute PJI (Early \u0026amp; Late acute)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.52 (0.43\u0026thinsp;~\u0026thinsp;14.65)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic PJI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.032\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.55 (1.11\u0026thinsp;~\u0026thinsp;11.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eSE, standard error; OR, odds ratio; CI, confidence interval; PJI, periprosthetic joint infection;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe distinct microbial profiles observed within the first 72 hours of culture support distinct pathogenic pathways of each PJI subtype. Early acute PJI is usually caused by direct intraoperative contamination, and its microbial spectrum is typically dominated by commensal bacteria on the skin, especially CoNS [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In contrast, Late acute PJI, which is primarily due to hematogenous dissemination, exhibits a broader microbial spectrum with a significantly higher proportion of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e and \u003cem\u003eStreptococcus\u003c/em\u003e spp, consistent with reports identifying them as common pathogens in hematogenous PJI [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These pathogens rapidly proliferate in the synovial fluid in a planktonic state, leading to high bacterial loads and severe acute inflammatory responses in the host. In Late chronic PJI, although \u003cem\u003eStaphylococcus aureus\u003c/em\u003e and \u003cem\u003eCoNS\u003c/em\u003e still dominate, multiple factors such as biofilm‑mediated protection and host immune factors jointly contribute to the complex phenomenon of bacterial species diversity [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Our findings, based on the dominant, rapidly growing isolates recovered within the first 3 days of culture, provide robust support for this framework, implicating these organisms as the primary causative pathogens in their respective PJI subtypes.\u003c/p\u003e \u003cp\u003eClinical decisions on incubation duration for PJI should be tailored to both the suspected pathogen and the infection subtype. This study reaffirms that a 7-day incubation period sufficiently detects most microorganisms in synovial fluid, consistent with previous reports [11]. We further observed that gram-negative bacilli, particularly \u003cem\u003eEnterobacteriaceae\u003c/em\u003e, consistently recovered within 5 days [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This may be attributed to their unique cell wall structure, which facilitate rapid proliferation in the host environment, thereby enabling earlier crossing of the diagnostic threshold [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In contrast, fungal detection presents greater complexity. While optimal incubation times range from 7 to 14 days [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e], previous studies lacked PJI subtype stratification. Our analysis provides crucial clarification on this point. In acute PJI, fungal pathogens were detected within 5 days, aligning with Morreel et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In contrast, all instances in our cohort in which extended incubation (\u0026gt;\u0026thinsp;5 days) was required for fungal recovery occurred in patients with chronic PJI. This pattern is consistent with the typically insidious process of chronic fungal infections. For patients with chronic PJI who have risk factors, a high degree of suspicion for fungal aetiology should be maintained, especially considering that approximately 20% of fungal PJI are polymicrobial [\u003cspan additionalcitationids=\"CR28\" citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe identified days 6\u0026ndash;7 as a critical inflection point in microbial culture. During this window, the yield of new pathogens declined markedly (from 32.6% to 8.3%), coinciding with a shift from highly virulent, fast-growers, to low-virulence, slow-growing organisms. Importantly, this transition manifested differently across PJI subtypes. In acute PJI, the microbial profile had already stabilised before day 7, with minimal new pathogen emergence thereafter. In contrast, chronic PJI demonstrated continued microbial detection beyond this timepoint, with a substantial proportion of isolates emerging after day 7. While several studies have questioned the cost-effectiveness of extending incubation beyond 7 days [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e], others have shown that late-growing isolates, particularly in chronic infections, may alter antimicrobial therapy selection [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. We, therefore, recommend selective extension of the incubation period for suspected chronic PJI, where late-growing microorganisms may significantly impact treatment decisions.\u003c/p\u003e \u003cp\u003ePrior antibiotic therapy was associated with a delay in microbial detection only in chronic infections, even though it was administered more frequently in acute cases, where no comparable delay was observed. Prior antibiotic therapy can reduce the sensitivity of microbial culture [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. However, Esteban et al. did not observe such a difference in their research [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. We observed that the growth of chronic PJI pathogenic bacteria is more susceptible to the influence of prior antibiotic therapy. Although the proportion of prior antibiotic therapy in acute PJI is higher, the effect is not significant. There are several potential explanations for this difference. First, acute PJI is usually treated with a short course of therapy, which can partially inhibit the planktonic bacteria, but due to the vigorous metabolism of the bacterial community, the bacteria can still rapidly multiply and reach the detection threshold. Second, in chronic PJI, bacteria are encased within a mature biofilm, leading to a dormant state. This enables them to be resistant to antibiotics [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Therefore, even with long-term antibiotic treatments in the past, these pathogens could not be eradicated [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Antibiotics eliminate the active planktonic bacteria, while the dormant subgroups persist [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. When cultured outside the body, these \u0026ldquo;persistent\u0026rdquo; cells require a longer incubation period before they can be detected [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Therefore, growth beyond day 7 may reflect the dormant pathogens within the biofilm; the antibiotic exposure itself cannot fully explain this phenomenon. Since our study only included synovial-fluid samples, further validation of the conclusions is still needed in terms of sample types.\u003c/p\u003e \u003cp\u003eOur study has some limitations. As a retrospective analysis, our study is subject to selection and information bias. Furthermore, the absence of a prospective 7-day control group precludes direct comparison of diagnostic yields, necessitating validation through randomised controlled trials. Finally, although phenotypic classification criteria for PJI have been established, in clinical practice, the boundary between acute and chronic infections is sometimes blurred and overlapping cases may exist. Future research should integrate molecular diagnostics with traditional culture to enhance detection efficiency while reducing time to diagnosis.\u003c/p\u003e \u003cp\u003eIn conclusion, based on synovial fluid cultures, an incubation period of 7 days is sufficient to detect most pathogenic bacteria in acute PJI, whereas the incubation period for chronic PJI should be extended to at least 10 days. The previous use of antibiotics did not affect the microbial incubation time for acute PJI. This finding needs to be confirmed in a larger prospective cohort. Whether these time ranges are applicable to the peri-prosthetic tissue and the ultrasound fluid requires further study.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of First Affiliated Hospital of Xinjiang Medical University (\u003cstrong\u003e220120-15\u003c/strong\u003e).The requirement for obtaining written informed consent from participants was waived by this Institutional Review Board (IRB)\u0026nbsp;due to the retrospective nature of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Science and Technology Innovation Team Project of Xinjiang Uygur Autonomous Region Science and Technology Department (2023TSYCTD0014), Major Special Projects of the Science and Technology Plan of Xinjiang Uygur Autonomous Region (2022A03011), and the Xinjiang Medical University Major Scientific Research Achievement Cultivation Project (XYD2024ZC01), 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShoujie Huo: Writing - original draft, Investigation, Data curation, Methodology. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eYicheng Li: Investigation, Validation, Data curation, Writing -original draft.\u003c/p\u003e\n\u003cp\u003eXiaobin Guo: Data curation, Methodology, Investigation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eXiaogang Zhang:Data curation, Methodology, Investigation.\u003c/p\u003e\n\u003cp\u003eLi Cao: Writing - review \u0026amp; editing, Conceptualization, Resources, Supervision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Science and Technology Innovation Team Project of Xinjiang Uygur Autonomous Region Science and Technology Department (2023TSYCTD0014), Major Special Projects of the Science and Technology Plan of Xinjiang Uygur Autonomous Region (2022A03011), and the Xinjiang Medical University Major Scientific Research Achievement Cultivation Project (XYD2024ZC01), 2024.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27:302\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel R. Periprosthetic Joint Infection. N Engl J Med. 2023;388:251\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: an evidence-based and validated criteria. J Arthroplasty.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSch\u0026auml;fer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis. 2008;47:1403\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDrago L, De Vecchi E, Cappelletti L, Vassena C, Toscano M, Bortolin M, Mattina R, Roman\u0026ograve; CL. Prolonging culture to 15 days improves bacterial detection in bone and joint infections. Eur J Clin Microbiol Infect Dis. 2015;34:1809\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosterton JW, Cheng KJ, Geesey GG, Ladd TI, Nickel JC, Dasgupta M, Marrie TJ. Bacterial biofilms in nature and disease. Annu Rev Microbiol. 1987;41:435\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eButler-Wu SM, Burns EM, Pottinger PS, Magaret AS, Rakeman JL, Matsen FA, Cookson III BT. Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection. J Clin Microbiol. 2011;49:2490\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKlement MR, Cunningham DJ, Wooster BM, Wellman SS, Bolognesi MP, Green CL, Garrigues GE. Comparing Standard Versus Extended Culture Duration in Acute Hip and Knee Periprosthetic Joint Infection. J Am Acad Orthop Surg. 2019;27(9):e437\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTarabichi S, Goh GS, Zanna L, Qadiri QS, Baker CM, Gehrke T, Citak M, Parvizi J. Time to Positivity of Cultures Obtained for Periprosthetic Joint Infection. J Bone Joint Surg Am. 2023;105(2):107\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTalsma DT, Ploegmakers JJW, Jutte PC, Kampinga G, WouthuyzenBakker M, Birlutiu RM, Stoica CI, Russu O, Cismasiu RS, Birlutiu V. Positivity Trends of Bacterial Cultures from Cases of Acute and Chronic Periprosthetic Joint Infections. J Clin Med. 2022;11(8):2238.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWood TK, Knabel SJ, Kwan BW. Bacterial persister cell formation and dormancy. Appl Environ Microbiol. 2013;79(23):7116\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeldman M, L\u0026ouml;wik C, Soriano A, Albiach L, Zijlstra WP, Knobben BAS, Jutte P, Sousa R, Carvalho A, Goswami K, Parvizi J, Belden KA, Wouthuy zen-Bakker M. If, when, and how to use rifampin in acute staphylococcal periprosthetic joint infections, a multicentre observational study. Clin Infect Dis. 2021;73:1634\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKramer TS, Soriano A, Tedeschi S, Chen AF, Tattevin P, Senneville E, Gomez-Junyent J, Birlutiu V, Petersdorf S, de Brito VD, Gonzalez IS, Belden KA, Wouthuyzen-Bakker M. Should We Use Rifampicin in Periprosthetic Joint Infections Caused by Staphylococci When the Implant Has Been Exchanged? A Multicenter Observational Cohort Study. Open Forum Infect Dis. 2024;11(3):ofae075.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorreel ERL, van Dessel HA, Geurts J, Savelkoul PHM, van Loo IHM. Prolonged incubation time unwarranted for acute periprosthetic joint infections. J Clin Microbiol. 2025;63(2):e0114324.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhanem E, Parvizi J, Clohisy J, Burnett S, Sharkey PF, Barrack R. Perioperative antibiotics should not be withheld in proven cases of periprosthetic infection. Clin Orthop Relat Res. 2007;461(461):44\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnagnostopoulos A, Bossard DA, Ledergerber B, Zingg PO, Zinkernagel AS, Gerber C, Achermann Y. Perioperative antibiotic prophylaxis has no effect on time to positivity and proportion of positive samples: a cohort study of 64 Cutibacterium acnes bone and joint infections. J Clin Microbiol. 2018;56(2):e01576-17-17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurdoch DR, Roberts SA, Fowler VG Jr, Shah MA, Taylor SL, Morris AJ, Corey GR. Infection of orthopedic prostheses after Staphylococcus aureus bacteremia. Clin Infect Dis. 2001;32:647\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSendi P, Banderet F, Graber P, Zimmerli W. Periprosthetic joint infection following Staphylococcus aureus bacteremia. J Infect. 2011;63:17\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKonigsberg BS, Valle CJ, Ting NT, Qiu F, Sporer SM. 3 September 2013, posting date. Acute hematogenous infection following total hip and knee arthroplasty. J. Arthroplasty [Epub ahead of print.].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eH\u0026oslash;iby N, Ciofu O, Johansen HK, Song ZJ, Moser C, Jensen P\u0026Oslash;, Molin S, Givskov M, Tolker-Nielsen T, Bjarnsholt T. The clinical impact of bacterial biofilms. Int J Oral Sci. 2011;3(2):55\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArciola CR, Campoccia D, Montanaro L. Implant infections: adhesion, biofilm formation and immune evasion. Nat Rev Microbiol. 2018;16(7):397\u0026ndash;409.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuhal R, Kataria R. Biofilm patterns in gram-positive and gram-negative bacteria. Microbiol Res. 2021;251:126829.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCobo J, Miguel LG, Euba G, Rodriguez D, Garcia-Lechuz JM, Riera M, Falgueras L, Palomino J, Benito N, del Toro MD, Pigrau C, Ariza J. Early prosthetic joint infection: outcomes with debridement and implant retention followed by antibiotic therapy. Clin Microbiol Infect. 2011;17:1632\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaez C, MacDonell R, Tishad A, Prieto HA, Miley EN, Deen JT, Gray CF, Parvataneni HK, Pulido L. Comparison of Five-Day vs. Fourteen-Day Incubation of Cultures for Diagnosis of Periprosthetic Joint Infection in Hip Arthroplasty. J Clin Med. 2024;13(15):4467.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu B, Lin Y, Su J, Lin L, Yu Z, Zhang C, Fang X, Huang Z, Zhang W. Extending the culture duration could not improve the culture positivity rate and clinical outcomes of periprosthetic joint infection. Front Cell Infect Microbiol. 2025;15:1551862.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzzam K, Parvizi J, Jungkind D, Hanssen A, Fehring T, Springer B, Bozic K, Della Valle C, Pulido L, Barrack R. Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience. J Bone Joint Surg Am. 2009;91(Suppl 6):142\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSidhu MS, Cooper G, Jenkins N, Jeys L, Parry M, Stevenson JD. Prosthetic fungal infections: poor prognosis with bacterial co-infection. Bone Joint J. 2019;101\u0026ndash;B(5):582\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSambri A, Zunarelli R, Fiore M, Bortoli M, Paolucci A, Filippini M, Zamparini E, Tedeschi S, Viale P, De Paolis M. Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature. Microorganisms. 2022;11(1):84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEsteban J, Alvarez-Alvarez B, Blanco A, Fern\u0026aacute;ndez-Roblas R, Gadea I, Garcia-Ca\u0026ntilde;ete J, Sandoval E, Valdazo M. Prolonged incubation time does not increase sensitivity for the diagnosis of implant-related infection using samples prepared by sonication of the implants. Bone Joint J. 2013;95\u0026ndash;B(7):1001\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeroche L, B\u0026eacute;mer P, Valentin AS, Jolivet-Gougeon A, Tand\u0026eacute; D, H\u0026eacute;ry-Arnaud G, Lemari\u0026eacute; C, Kempf M, Bret L, Burucoa C, Corvec S, Plouzeau C. The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections. J Clin Med. 2019;8(12):2113.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrampuz A, Piper KE, Jacobson MJ, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357:654\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGazendam A, Wood TJ, Tushinski D, Bali K. Diagnosing Periprosthetic Joint Infection: a Scoping Review. Curr Rev Musculoskelet Med. 2022;15(3):219\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFisher C, Patel R. Rifampin, Rifapentine, and Rifabutin Are Active against Intracellular Periprosthetic Joint Infection-Associated Staphylococcus epidermidis. Antimicrob Agents Chemother. 2021;65(2):e01275\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteixner SJM, Spiegel C, Dammerer D, Wurm A, Nogler M, Cora\u0026ccedil;a-Huber DC. Influence of Nutrient Media Compared to Human Synovial Fluid on the Antibiotic Susceptibility and Biofilm Gene Expression of Coagulase-Negative Staphylococci In Vitro. Antibiot (Basel). 2021;10(7):790.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamad C, Chowdhry M, Sindeldecker D, Bernthal NM, Stoodley P, McPherson EJ. Adaptive antimicrobial resistance, a description of microbial variants, and their relevance to periprosthetic joint infection. Bone Joint J. 2022;104\u0026ndash;B(5):575\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mcro","sideBox":"Learn more about [BMC Microbiology](http://bmcmicrobiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mcro","title":"BMC Microbiology","twitterHandle":"#bmcmicrobiology","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Periprosthetic joint infection, Culture, Incubation time, Arthroplasty, Bacteria","lastPublishedDoi":"10.21203/rs.3.rs-8751356/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8751356/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eStandard 14-day incubation protocols for periprosthetic joint infections (PJIs) lack specificity.The optimal culture duration for distinct acute and chronic PJI remains undefined. This study aimed to define the microbial time-to-positivity (TTP) and distribution in different PJI categories to evaluate the feasibility of a stratified culture strategy.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study analysed the medical records of patients from 1 June 2016 to 1 July 2024. Patients who met the Musculoskeletal Infection Society (MSIS) criteria and had positive intraoperative synovial-fluid cultures were classified into Early acute PJI, Late acute PJI, and Late chronic PJI based on clinical symptoms. The microbial spectrum and TTP of synovial-fluid specimens were recorded. The microbial profiles and detection rates of different PJI subtypes were compared across different time stages.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe included 181 patients (mean age 65 years). Among them, 41 cases were Early acute PJI; 35 cases, Late acute PJI; and 105 Late chronic PJI. All pathogens recovered within 12 days. In Early acute PJI and Late acute PJI, 90.3 and 94.3% of pathogens, respectively, grew by day 7, whereas 96.2% of Late chronic PJI isolates required up to 10 days. The rate of new microbial detection decreased sharply after day 5 of incubation. After 7 days, delayed microbial growth was predominantly seen in the Late chronic PJI cohort. Previous antibiotic exposure did not significantly affect the growth of microorganisms in acute PJI (OR\u0026thinsp;=\u0026thinsp;2.52, 95% CI 0.43\u0026ndash;14.65; P\u0026thinsp;=\u0026thinsp;0.31).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePrevious use of antibiotics prolongs the incubation time of microorganisms but has a limited effect on the incubation time of microorganisms in acute PJI. A 7-day incubation period is sufficient to reliably detect pathogen in acute PJI. For chronic PJI, considering the delayed growth of some pathogen, at least 10 days of culture are required.\u003c/p\u003e","manuscriptTitle":"Optimal Incubation Time for Synovial-Fluid Cultures in Acute and Chronic Periprosthetic Joint Infection: A Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-02 08:43:48","doi":"10.21203/rs.3.rs-8751356/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-13T09:37:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"85883126082072968755468917935872869819","date":"2026-03-06T01:36:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12151455265783891355673565506200495504","date":"2026-02-27T07:46:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T19:21:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-23T11:06:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-04T03:09:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-03T18:58:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Microbiology","date":"2026-02-03T18:53:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-microbiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mcro","sideBox":"Learn more about [BMC Microbiology](http://bmcmicrobiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/mcro","title":"BMC Microbiology","twitterHandle":"#bmcmicrobiology","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd6daf0b-ea60-4ac3-a54c-88bfb318fe64","owner":[],"postedDate":"March 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T08:43:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-02 08:43:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8751356","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8751356","identity":"rs-8751356","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}