Abstract
Introduction: Periprosthetic joint infection (PJI) is the most serious complication after arthroplasty, and the diagnosis of PJI is still challenging with modern medical technology. To improve the diagnostic rate, combined diagnostic methods are gradually beginning to be used to diagnose PJI. Sonication is one accurate way to diagnose PJI, but there is minimal research regarding the diagnostic value of sonicate fluid (SF) in blood culture bottles (BCB). Therefore, we evaluated this combined diagnostic method by meta-analysis.Methods: We searched English publications in electronic databases regarding the use of sonicate fluid in blood culture bottles (SF-BCB) for diagnosing PJI, screened the literature according to inclusion criteria, assessed the quality of the selected literature, and collected information regarding SF-BCB.Results: This meta-analysis includes 4 studies that evaluated SF-BCB for the diagnosis of PJI. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) are 0.85 (95% Confidence interval [CI], 0.77 to 0.91), 0.86 (CI, 0.81 to 0.91), 5.34 (CI, 3.13 to 9.11), 0.16 (CI, 0.06 to 0.48) and 39.01 (CI, 9.04 to 168.35), respectively. The area under the curve (AUC) of the summary receiver operating characteristic (SROC) is 0.9186 (standard error, 0.0205).Conclusion: SF-BCB has great value for the microbiological diagnosis of PJ, especially for patients with prior antibiotic treatment.
Highlights
Periprosthetic joint infection (PJI) is the most serious complication after arthroplasty, and the diagnosis of PJI is still challenging with modern medical technology
The selected articles had to meet the following inclusion criteria: 1. The diagnosis of PJI is based on criteria from the Musculoskeletal Infection Society (MSIS), the European Bone and Joint Infection Society (EBJIS) and the Infectious Diseases Society of America (IDSA) [17]; or strong evidence of infection, such as the presence of a sinus tract, purulence around the prosthesis, acute inflammation in periprosthetic tissue, or microbial growth in the synovial fluid, periprosthetic tissue samples, or sonicate fluid (SF)
After literature review of the title, the abstract and the full text of the articles, 4 studies are included in the diagnostic meta-analysis [10, 12,13,14], including 3 articles from European countries (Germany, Spain, and Greece) and 1 study from China
Summary
Periprosthetic joint infection (PJI) is the most serious complication after arthroplasty, and the diagnosis of PJI is still challenging with modern medical technology. To improve the diagnostic rate, combined diagnostic methods are gradually beginning to be used to diagnose PJI. Sonication is one accurate way to diagnose PJI, but there is minimal research regarding the diagnostic value of sonicate fluid (SF) in blood culture bottles (BCB). We evaluated this combined diagnostic method by meta-analysis. Because there is no gold standard to diagnose the existence of biofilms on the surface of a joint prosthesis, the diagnosis of PJI is difficult [2]. The high sensitivity and specificity of SFC at different locations with PJI have been reported [4, 5]. The sensitivity and specificity are 89% and 100%, respectively
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