{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:41:41Z","timestamp":1792626101254,"version":"4.5.0"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100011892","name":"Kaohsiung Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CMRPG8N1281"],"award-info":[{"award-number":["CMRPG8N1281"]}],"id":[{"id":"10.13039\/501100011892","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The clinical significance of a single unexpected positive intraoperative culture (UPC) during aseptic revision arthroplasty remains unclear. This study primarily aimed to evaluate the association between postoperative antibiotic duration and treatment failure in patients with a single UPC after aseptic revision total hip or knee arthroplasty. A secondary aim was to compare failure\u2010free survival between patients with a single UPC and those with multiple UPCs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed 51 presumed aseptic revision hip or knee arthroplasties with UPCs performed between January 1999 and December 2023. Cases meeting the 2018 ICM criteria for periprosthetic joint infection were excluded. Postoperative antibiotic duration was the exposure of interest. Treatment failure, defined as infection\u2010related re\u2010revision, was the primary outcome; failure\u2010free survival was the secondary outcome. Continuous variables were compared using the Mann\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      test, and categorical variables were compared using chi\u2010square or Fisher's exact tests. Factors associated with failure were examined using univariate logistic regression, and failure\u2010free survival was assessed using Kaplan\u2013Meier analysis with the log\u2010rank test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 39 patients with one UPC, treatment failure occurred in 18%. Antibiotic courses longer than 21\u2009days were associated with failure (OR 28.1). In the small subgroup with available data (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913), synovial biomarkers did not show a statistically significant difference between success and failure groups. Patients with one UPC had better failure\u2010free survival than those with \u2265\u20092 UPCs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The observed association between prolonged antibiotic therapy and treatment failure may reflect underlying infection severity rather than a causal effect of antibiotic duration. Individualized management is recommended for UPCs in aseptic revision arthroplasty.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70452","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:21:01Z","timestamp":1792624861000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative Antibiotic Duration and Treatment Failure After Aseptic Revision Arthroplasty With a Single Unexpected Positive Culture: A Retrospective Cohort Study"],"prefix":"10.1111","author":[{"given":"Hao\u2010Chang","family":"Hsieh","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery E\u2010Da Hospital\/I\u2010Shou University  Kaohsiung, Taiwan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5205-8333","authenticated-orcid":false,"given":"Feng\u2010Chih","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Kaohsiung Chang Gung Memorial Hospital  Kaohsiung, Taiwan China"},{"name":"College of Medicine Chang Gung University  Kaohsiung, Taiwan China"},{"name":"Center for General Education Cheng Shiu University  Kaohsiung, Taiwan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen Herng Shouh","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Kaohsiung Chang Gung Memorial Hospital  Kaohsiung, Taiwan China"},{"name":"College of Medicine Chang Gung University  Kaohsiung, Taiwan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih\u2010Hsiang","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Kaohsiung Chang Gung Memorial Hospital  Kaohsiung, Taiwan China"},{"name":"College of Medicine Chang Gung University  Kaohsiung, Taiwan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po\u2010Chun","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Kaohsiung Chang Gung Memorial Hospital  Kaohsiung, Taiwan China"},{"name":"College of Medicine Chang Gung University  Kaohsiung, Taiwan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7643-2315","authenticated-orcid":false,"given":"Cheng\u2010Ta","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Kaohsiung Chang Gung Memorial Hospital  Kaohsiung, Taiwan China"},{"name":"College of Medicine Chang Gung University  Kaohsiung, Taiwan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"issue":"6","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"S79","DOI":"10.1016\/j.arth.2020.02.030","article-title":"Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2030","volume":"35","author":"Schwartz A. M.","year":"2020","journal-title":"Journal of Arthroplasty"},{"issue":"8","key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"2700","DOI":"10.1007\/s11999-015-4220-2","article-title":"What Host Factors Affect Aseptic Loosening After THA and TKA?","volume":"473","author":"Cherian J. J.","year":"2015","journal-title":"Clinical Orthopaedics and Related Research"},{"issue":"11","key":"e_1_2_14_4_1","doi-asserted-by":"crossref","first-page":"2181","DOI":"10.1016\/j.arth.2014.07.010","article-title":"Unexpected Positive Intraoperative Cultures in Aseptic Revision Arthroplasty","volume":"29","author":"Saleh A.","year":"2014","journal-title":"Journal of Arthroplasty"},{"issue":"11","key":"e_1_2_14_5_1","first-page":"1482","article-title":"The Unsuspected Prosthetic Joint Infection: Incidence and Consequences of Positive Intra\u2010Operative Cultures in Presumed Aseptic Knee and Hip Revisions","volume":"99","author":"Jacobs A. M. E.","year":"2017","journal-title":"Bone & Joint Journal"},{"issue":"6","key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.arth.2007.03.029","article-title":"The Fate of the Unexpected Positive Intraoperative Cultures After Revision Total Knee Arthroplasty","volume":"22","author":"Barrack R. L.","year":"2007","journal-title":"Journal of Arthroplasty"},{"issue":"11","key":"e_1_2_14_7_1","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.RVW.24.00137","article-title":"Unexpected Positive Cultures in Presumed Aseptic Revision Total Hip Arthroplasty: A Systematic Review and Meta\u2010Analysis of Incidence, Risk Factors, Management, and Outcomes","volume":"12","author":"Mirghaderi P.","year":"2024","journal-title":"JBJS Reviews"},{"issue":"5","key":"e_1_2_14_8_1","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.arth.2018.02.078","article-title":"The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence\u2010Based and Validated Criteria","volume":"33","author":"Parvizi J.","year":"2018","journal-title":"Journal of Arthroplasty"},{"issue":"10","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"2996","DOI":"10.1016\/j.arth.2020.05.029","article-title":"Do Positive Cultures at Second Stage re\u2010Implantation Increase the Risk for Reinfection in Two\u2010Stage Exchange for Periprosthetic Joint Infection?","volume":"35","author":"Theil C.","year":"2020","journal-title":"Journal of Arthroplasty"},{"issue":"6","key":"e_1_2_14_10_1","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1097\/CORR.0000000000000609","article-title":"A Single Positive Tissue Culture Increases the Risk of Rerevision of Clinically Aseptic THA: A National Register Study","volume":"477","author":"Milandt N. R.","year":"2019","journal-title":"Clinical Orthopaedics and Related Research"},{"issue":"10","key":"e_1_2_14_11_1","doi-asserted-by":"crossref","DOI":"10.3390\/biomedicines12102247","article-title":"Undiagnosed Periprosthetic Infections in First\u2010Time Aseptic Revision Hip Arthroplasties","volume":"12","author":"Caternicchia F.","year":"2024","journal-title":"Biomedicines"},{"key":"e_1_2_14_12_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jor.2019.06.028","article-title":"Unexpected Positive Intraoperative Cultures (UPIC) in Revision Hip and Knee Arthroplasty\u2010 A Review of the Literature","volume":"17","author":"Purudappa P. P.","year":"2020","journal-title":"Journal of Orthopaedics"},{"issue":"10","key":"e_1_2_14_13_1","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1302\/2633-1462.510.BJO-2024-0032.R1","article-title":"Unexpected Positive Cultures in Aseptic Revision Hip and Knee Arthroplasty","volume":"5","author":"Kayani B.","year":"2024","journal-title":"Bone & Joint Open"},{"issue":"2","key":"e_1_2_14_14_1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.5194\/jbji-10-51-2025","article-title":"Postoperative Antibiotic Treatment Does Not Lower Re\u2010Revision Rate in Presumed Aseptic Hip and Knee Revision Arthroplasties With Unexpected Positive Intraoperative Cultures\u2014A Matched Cohort Study","volume":"10","author":"Simon S.","year":"2025","journal-title":"Journal of Bone and Joint Infection"},{"issue":"15","key":"e_1_2_14_15_1","first-page":"1392","article-title":"Prevalence and Outcomes of Unexpected Positive Intraoperative Cultures in Presumed Aseptic Revision Hip Arthroplasty","volume":"103","author":"Neufeld M. E.","year":"2021","journal-title":"Journal of Bone and Joint Surgery. American Volume"},{"issue":"8","key":"e_1_2_14_16_1","doi-asserted-by":"crossref","first-page":"3129","DOI":"10.1007\/s00586-024-08229-2","article-title":"Unexpected Positive Culture (UPC) in Adults Revision Spine Surgery: A Systematic Review and Meta\u2010Analysis of Incidence, Risk Factors, and Management","volume":"33","author":"Mirghaderi P.","year":"2024","journal-title":"European Spine Journal"},{"issue":"4","key":"e_1_2_14_17_1","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.spinee.2022.10.016","article-title":"Unexpected Intraoperative Positive Culture (UIPC) in Presumed Aseptic Revision Spine Surgery: A Systematic Review and Meta\u2010Analysis","volume":"23","author":"Aldahamsheh O.","year":"2023","journal-title":"Spine Journal"},{"issue":"2","key":"e_1_2_14_18_1","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1007\/s00402-023-05103-6","article-title":"Surprise Positive Culture Rate in the Treatment of Presumed Aseptic Long\u2010Bone Nonunion: A Systematic Review With Meta\u2010Analysis of 2397 Patients","volume":"144","author":"Wagner R. K.","year":"2024","journal-title":"Archives of Orthopaedic and Trauma Surgery"},{"issue":"7","key":"e_1_2_14_19_1","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1111\/os.13333","article-title":"Clinical Outcomes of Culture\u2010Negative and Culture\u2010Positive Periprosthetic Joint Infection: Similar Success Rate, Different Incidence of Complications","volume":"14","author":"Xu Z.","year":"2022","journal-title":"Orthopaedic Surgery"},{"issue":"3","key":"e_1_2_14_20_1","article-title":"The False\u2010Positive Rate of Synovial Fluid Culture at a Single Clinical Laboratory Using Culture Bottles","volume":"16","author":"Deirmengian C.","year":"2024","journal-title":"Cureus"},{"issue":"1","key":"e_1_2_14_21_1","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.arth.2024.07.031","article-title":"Prevalence and Impact of Unexpected Positive Intraoperative Cultures in Total Hip or Knee Revision Surgery","volume":"40","author":"Vargas\u2010Reveron C.","year":"2025","journal-title":"Journal of Arthroplasty"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70452","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.70452","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70452","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T23:21:04Z","timestamp":1792624864000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.70452"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,21]]},"references-count":20,"alternative-id":["10.1111\/os.70452"],"URL":"https:\/\/doi.org\/10.1111\/os.70452","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,21]]},"assertion":[{"value":"2026-04-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"os.70452"}}