Culture-negative Prosthetic Joint Arthritis Related to Coxiella burnetii

BACKGROUND: The number of hip and knee arthroplasty procedures is steadily increasing as life expectancy increases. Coxiella burnetii may be responsible for culture-negative prosthetic joint arthritis and is associated with antibiotic failure and repeated surgeries. We report the first case series of C. burnetii-related culture-negative prosthetic joint arthritis. METHODS: Cases were retrieved from the French National Referral center for Q fever. Diagnosis was based on (18)fluorodeoxyglucose positron emission tomography, serology, broad-range polymerase chain reaction, and C. burnetii-specific polymerase chain reaction. RESULTS: Four cases of C. burnetii-related culture-negative prosthetic joint arthritis were found. Standard bacteriologic procedures would have missed the diagnosis in all cases. Etiologic diagnosis improved the outcome in all but 1 case. CONCLUSIONS: A systematic, comprehensive diagnostic strategy should be used in culture-negative prosthetic joint arthritis, including testing for C. burnetii in endemic areas. (C) 2014 Elsevier Inc. All rights reserved.