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.
