Culture-negative surgical site infections

Background: The appearance of postoperative surgical site infection (SSI) in the absence of culturable bacterial pathogens is a common dilemma for the surgeon. Methods: The literature was searched through references to primary articles, as well as a MEDLINE review, for reports of culture-negative SSIs. Results: Potential causes of culture-negative SSIs include prior antimicrobial therapy; the presence of fastidious or slow-growing microorganisms such as mycobacteria, Mycoplasma spp., and Legionella spp.; infection caused by mundane bacteria that may be dismissed as "contaminants"; factitious infection; and others. Conclusions: We review the recognized causes of "culture negative" SSIs and discuss the laboratory capabilities that may enhance recognition of many of these pathogens and management options.