Abstract
BackgroundA combination of laboratory, histopathological and microbiological tests for diagnosis of prosthetic joint infection (PJI) have been strongly recommended. This study aims to characterize the accuracy of individual or group tests, such as culture of sonicate fluid, synovial fluid and peri-implant tissue, C-reactive protein (CRP) and histopathology for detection of early, delayed and late PJI.MethodsA prospective study of patients undergoing hip or knee arthroplasty from February 2009 to February 2014 was performed in a Spanish tertiary health care hospital. The diagnostic accuracy of the different methods was evaluated constructing receiver-operating-characteristic (ROC) curve areas.ResultsOne hundred thirty consecutive patients were included: 18 (13.8%) early PJI, 35 (27%) delayed PJI and 77 (59.2%) late PJI. For individual parameters, the area under the ROC curve for peri-implant tissue culture was larger for early (0.917) than for delayed (0.829) and late PJI (0.778), p = 0.033. There was a significantly larger difference for ROC area in the synovial fluid culture for delayed (0.803) than for early (0.781) and late infections (0.679), p = 0.039. The comparison of the areas under the ROC curves for the two microbiological tests showed that sonicate fluid was significantly different from peri-implant tissue in delayed (0.951 vs 0.829, p = 0.005) and late PJI (0.901 vs 0.778, p = 0.000). The conjunction of preoperative parameters, synovial fluid culture and CRP, improved the accuracy for late PJI (p = 0.01). The conjunction of histopathology and sonicate fluid culture increased the area under ROC curve of sonication in early (0.917 vs 1.000); p = 0.06 and late cases (0.901 vs 0.999); p < 0.001.ConclusionFor early PJI, sonicate fluid and peri-implant tissue cultures achieve the same best sensitivity. For delayed and late PJI, sonicate fluid culture is the most sensitive individual diagnostic method. By combining histopathology and peri-implant tissue, all early, 97% of delayed and 94.8% of late cases are diagnosed. The conjunction of histopathology and sonicate fluid culture yields a sensitivity of 100% for all types of infection.
Highlights
A combination of laboratory, histopathological and microbiological tests for diagnosis of prosthetic joint infection (PJI) have been strongly recommended
The aim of this study was to compare the diagnostic accuracy of the individual or grouped tests such as sonicate fluid, synovial fluid and peri-implant tissue culture, C reactive protein (CRP) and histopathology for the detection of early, delayed and late PJI, as this would allow us to enhance the diagnosis of each type of orthopedic implant infection
PJI was diagnosed according to the criteria proposed by Berbari et al by the presence of at least one of the following [10]: (i) visible purulence surrounding the prosthesis, (ii) acute inflammation on histopathologic examination of permanent tissue sections, (iii) a sinus tract communicating with the prosthesis (iv) two or more cultures of joint aspirates or cultures of intraoperative tissue specimens yielded the same microorganism when S. aureus or S. lugdunensis were the microorganisms isolated, only a single positive tissue specimen was required
Summary
A combination of laboratory, histopathological and microbiological tests for diagnosis of prosthetic joint infection (PJI) have been strongly recommended. This study aims to characterize the accuracy of individual or group tests, such as culture of sonicate fluid, synovial fluid and peri-implant tissue, C-reactive protein (CRP) and histopathology for detection of early, delayed and late PJI. The successful management of patients with prosthetic joint infection (PJI) depends on an early and accurate diagnosis. The aim of this study was to compare the diagnostic accuracy of the individual or grouped tests such as sonicate fluid, synovial fluid and peri-implant tissue culture, C reactive protein (CRP) and histopathology for the detection of early, delayed and late PJI, as this would allow us to enhance the diagnosis of each type of orthopedic implant infection Fernández-Sampedro et al BMC Infectious Diseases (2017) 17:592 the evaluation of sensitivity and specificity of different diagnostic methods for implant-related infections, there is a lack of published data outlining their usefulness based on the time to infection [7, 8].
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