scholarly journals New Methods in the Diagnosis of Prosthetic Joint Infection

2019 ◽  
Vol 25 (4) ◽  
pp. 56-63
Author(s):  
S. Karbysheva ◽  
N. Renz ◽  
K. Yermak ◽  
S. Cabric ◽  
A. Trampuz
Keyword(s):  
Synovial Fluid ◽  
Multiplex Pcr ◽  
Sensitivity And Specificity ◽  
Leukocyte Count ◽  
Joint Infection ◽  
Accurate Diagnosis ◽  
Confirmatory Test ◽  
New Methods ◽  
Synovial Fluid Culture ◽  
Fluid Culture

A timely and accurate diagnosis of periprosthetic joint infection (PJI) is crucial to plan adequate treatment. Purpose of the study. To evaluate the performance of new diagnostic tests for the diagnosis of PJI. Material and Methods. The performance of novel biomarkers in synovial fluid (i.e. D-lactate and alfa-defensin), molecular test (i.e. PCR of synovial fluid and sonication fluid), new methods to dislodge biofilm from implant surface (i.e. MicroDTTect) and sonication of explanted prosthesis were investigated in patients with PJI and aseptic loosening of the prosthesis. Results. D-lactate showed better sensitivity for the diagnosis of PJI compared to leukocyte count (86% and 80%, respectively). The optimal D-lactate cut-off value was calculated at 1.26 mmol/l. The ADLF test showed sensitivity of 84%, 67% and to 54% depending on classification criteria used for the diagnosis of PJI (Musculoskeletal Infection Society (MSIS), The Infectious Diseases Society of America (IDSA) and proposed European Bone and Joint Infection Society (EBJIS) criteria, respectively). Using the proposed EBJIS definition criteria, the sensitivity of the leukocyte count was significantly higher than that of the ADLF test (86% compared with 54%; p<0,001), particularly in chronic PJI (81% compared with 44%, respectively; p<0,001). The sensitivity of synovial fluid PCR was 60% and herewith comparable with synovial fluid culture (52%, p = 0,239). The sensitivity and specificity of sonication fluid culture were 58% and 100%, which was comparable to sonication fluid PCR 51% and 94%, respectively. DTT-based method showed low sensitivity for diagnosis of PJI (40%) compared to sonication (80%, p<0,01). Conclusion. Synovial fluid D-lactate demonstrated good analytical performance and diagnostic value for the diagnosis of PJI. In particular, the high sensitivity for diagnosing infection and rapid availability of the test result make synovial fluid D-lactate suitable as screening test, whereas ADLF had limited sensitivity (54%) but high specificity (>95%) and it should therefore not be used for screening, but rather as a confirmatory test for PJI. Multiplex PCR of synovial fluid and sonication fluid has similar sensitivity and specificity compared to synovial fluid culture, having the advantage of rapid availability of results (within 5 hours) and fully automated process. With further improvement of its performance and inclusion of additional primers, multiplex PCR may complement conventional cultures, especially for rapid and accurate diagnosis of low-grade PJI. Culture of samples obtained by sonication of prostheses showed better sensitivity for the microbiologic diagnosis of prosthetic hip and knee infection compared to chemical based dislodgement such as MicroDTTect.

scholarly journals Synovial Fluid Aspiration Should Not Be Routinely Performed during the Two-Stage Exchange of the Knee

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Sebastian P. Boelch ◽  
Magnus Roth ◽  
Joerg Arnholdt ◽  
Maximilian Rudert ◽  
Martin Luedemann
Keyword(s):  
Synovial Fluid ◽  
Blood Cell ◽  
Sensitivity And Specificity ◽  
Pathogen Detection ◽  
Joint Infection ◽  
Youden Index ◽  
Blood Cell Count ◽  
Two Stage ◽  
Synovial Fluid Culture ◽  
Fluid Culture

Purpose. Detection of infection persistence during the two-stage exchange of the knee for periprosthetic joint infection is challenging. Synovial fluid culture (SFC) and synovial white blood cell count (SWBCC) before joint reimplantation are widespread diagnostic means for this indication. The sensitivity and specificity of SFC and of SWBCC for infection persistence before planned reimplantation were evaluated. Methods. 94 two-stage exchanges of the knee with synovial fluid aspiration performed after a drug holiday of at least 14 days and before reimplantation or spacer exchange (planned reimplantation) were retrospectively analyzed. Only cases with at least 3 intraoperative samples at planned reimplantation were included. SFC and SWBCC were compared to pathogen detection (SFC(culture)/SWBCC(culture)) and to histopathological signs of infection persistence (SFC(histo)/SWBCC(histo)) from intraoperative samples at planned reimplantation. For SFC, the sensitivity and specificity were calculated. For SWBCC, the optimal cut-off value with its sensitivity and specificity was calculated with the Youden-Index. Results. Sensitivity and specificity of SFC(culture) were 0.0% and 98.9%. Sensitivity and specificity of SFC(histo) were 3.4% and 100%. The optimal cut-off value for SWBCC(culture) was 4450 cells/μl with a sensitivity of 50.0% and a specificity of 86.5%. The optimal cut-off value for SWBCC(histo) was 3250 cells/μl with a sensitivity of 35.7% and a specificity of 92.9%. Conclusion. The detection of infection persistence remains challenging and a consented approach is lacking. The results do not warrant the routine performance of SFC during the two-stage exchange at the knee. SWBCC can be used to confirm infection persistence at high cut-offs, but they only occur in few patients and are therefore inappropriate for the routine use.

scholarly journals The Role of Biopsy in Diagnosing Infection After Hip and Knee Arthroplasty: A Meta-Analysis

2021 ◽  
Author(s):  
Cheng Li ◽  
Nan Jiang ◽  
Donara Margaryan ◽  
Carsten Perka ◽  
Andrej Trampuz
Keyword(s):  
Synovial Fluid ◽  
Quality Assessment ◽  
Sensitivity And Specificity ◽  
Preoperative Diagnosis ◽  
Meta Analysis ◽  
Microbial Culture ◽  
Combined Method ◽  
Knee Infection ◽  
Synovial Fluid Culture ◽  
Fluid Culture

Abstract Background Early diagnosis of periprosthetic hip and knee infection still represents a major challenge, as no single test can achieve ideal results. Currently, multiple preoperative indicators were performed to diagnose periprosthetic joint infection (PJI) to confirm or exclude infection in the early stage. However, the diagnostic value of biopsy-related tests in diagnosing periprosthetic hip and knee infection remains unclear.Methods Publications in PubMed, Embase, and the Web of Science databases were searched systematically until October 2020. Inclusion and exclusion criteria were used for screening biopsy-related studies of the diagnosis of periprosthetic hip and knee infection. All relevant tests were analyzed using Meta-Disc. For comparison between biopsy-related and conventional diagnostic methods in the diagnosis of PJI, the sensitivity and specificity of selected studies were calculated in the subgroup and compared using the z-test. Quality assessment of the selected literature was performed using the Quality Assessment of Diagnostic Accuracy Studies.Results Three biopsy-related tests were identified in 14 articles and further analyzed in the present meta-analysis. The pooled sensitivity and specificity was 0.90 (95% confidence interval [CI], 0.87–0.93), 0.97 (95% CI, 0.95–0.98) for the combined method (microbial culture plus histology), 0.76 (95% CI: 0.71–0.80) and 0.94 (95% CI: 0.91–0.95) for microbiological tests, and 0.62 (95% CI: 0.45–0.77), 0.97 (95% CI: 0.92–0.99) for histology. The pooled diagnostic odds ratios for diagnosing PJI using the combined method, microbiological test, and histology were 229.61 (95% CI: 94.90–555.56), 40.44 (95% CI: 23.74–68.89), and 54.47 (95% CI: 11.66–254.43), respectively. The combined method had the highest value for the area under the curve (0.9805), followed by histology (0.9425) and microbiological tests (0.9292). In the subgroup, statistical differences were identified in sensitivity and specificity for PJI diagnosis between the synovial fluid culture and biopsy culture group (P＜0.001), as well as in the biopsy-related combined method and serum C-reactive protein (CRP; P＜0.001).ConclusionsBiopsy culture does not appear to be advantageous compared to synovial fluid culture in the preoperative diagnosis of periprosthetic hip and knee infection. In contrast, combined biopsy microbial culture with histology analysis shows great potential in improving the preoperative diagnosis of PJI. The standard procedure of biopsy needs to be further explored. Further research is required to verify our results.

scholarly journals Direct Detection and Identification of Prosthetic Joint Infection Pathogens in Synovial Fluid by Metagenomic Shotgun Sequencing

2018 ◽  
Vol 56 (9) ◽  
Author(s):  
Morgan I. Ivy ◽  
Matthew J. Thoendel ◽  
Patricio R. Jeraldo ◽  
Kerryl E. Greenwood-Quaintance ◽  
Arlen D. Hanssen ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Shotgun Sequencing ◽  
Species Level ◽  
Prosthetic Joint ◽  
Synovial Fluid Culture ◽  
Culture Negative ◽  
Aseptic Failure ◽  
Fluid Culture

ABSTRACTMetagenomic shotgun sequencing has the potential to transform how serious infections are diagnosed by offering universal, culture-free pathogen detection. This may be especially advantageous for microbial diagnosis of prosthetic joint infection (PJI) by synovial fluid analysis since synovial fluid cultures are not universally positive and since synovial fluid is easily obtained preoperatively. We applied a metagenomics-based approach to synovial fluid in an attempt to detect microorganisms in 168 failed total knee arthroplasties. Genus- and species-level analyses of metagenomic sequencing yielded the known pathogen in 74 (90%) and 68 (83%) of the 82 culture-positive PJIs analyzed, respectively, with testing of two (2%) and three (4%) samples, respectively, yielding additional pathogens not detected by culture. For the 25 culture-negative PJIs tested, genus- and species-level analyses yielded 19 (76%) and 21 (84%) samples with insignificant findings, respectively, and 6 (24%) and 4 (16%) with potential pathogens detected, respectively. Genus- and species-level analyses of the 60 culture-negative aseptic failure cases yielded 53 (88%) and 56 (93%) cases with insignificant findings and 7 (12%) and 4 (7%) with potential clinically significant organisms detected, respectively. There was one case of aseptic failure with synovial fluid culture growth; metagenomic analysis showed insignificant findings, suggesting possible synovial fluid culture contamination. Metagenomic shotgun sequencing can detect pathogens involved in PJI when applied to synovial fluid and may be particularly useful for culture-negative cases.

scholarly journals The Concordance between Preoperative Aspiration and Intraoperative Synovial Fluid Culture Results: Intraoperative Synovial Fluid Re-Cultures Are Necessary whether the Preoperative Aspiration Culture is Positive or Not.

2021 ◽  
Author(s):  
Hao Li ◽  
Chi Xu ◽  
Libo Hao ◽  
Wei Chai ◽  
Jun Fu ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Positive Predictive Value ◽  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Pathogen Identification ◽  
Culture Growth ◽  
Sensitivity Specificity ◽  
Synovial Fluid Culture ◽  
Fluid Culture

Abstract Aims: Preoperative aspiration culture and intraoperative cultures play pivotal roles in periprosthetic joint infection (PJI) diagnosis and pathogen identification. But the discordance between preoperative aspiration culture and intraoperative synovial fluid culture remains unknown. We aim to determine 1）the discordance between preoperative and intraoperative synovial fluid (SF) culture and. 2) compared to intraoperative synovial fluid cultures, the sensitivity of preoperative aspiration fluid culture. Then the following question is tried to be answered: Are intraoperative synovial fluid re-cultures necessary if the preoperative aspiration culture is positive?Materials and methods:Between 2015 and 2019, 187 PJI patients managed with surgeries were included in this study. Compared to intraoperative synovial fluid culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative aspiration culture were calculated. Then, the discordance between preoperative aspiration culture and intraoperative SF culture was analyzed. Results:The sensitivity of preoperative aspiration culture was 81.29% compared to intraoperative synovial fluid cultures. Concordance was identified in 147 PJI (78.61%) patients and culture discordance occurred in 40 patients (21.39%). In these discordant PJI patients, 24 patients (60%) were polymicrobial and no intraoperative synovial fluid culture growth was found in 16 PJI cases (40%). Preoperative monomicrobial staphylococcus results had a sensitivity of and a specificity of 80.43% and 83.16%, respectively. Preoperative polymicrobial results had the lowest sensitivity.Conclusions: The intraoperative synovial fluid re-cultures are necessary if the preoperative aspiration culture is positive and the discordance between preoperative aspiration culture and intraoperative synovial fluid culture should be noted especially when streptococcus spp. and more than one pathogen was revealed by preoperative aspiration culture.

scholarly journals The concordance between preoperative aspiration and intraoperative synovial fluid culture results: intraoperative synovial fluid re-cultures are necessary whether the preoperative aspiration culture is positive or not

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hao Li ◽  
Chi Xu ◽  
LiBo Hao ◽  
Wei Chai ◽  
Fu Jun ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Joint Infection ◽  
Pathogen Identification ◽  
Level Of Evidence ◽  
Culture Growth ◽  
Sensitivity Specificity ◽  
Synovial Fluid Culture ◽  
Fluid Culture

Abstract Aims Preoperative aspiration culture and intraoperative cultures play pivotal roles in periprosthetic joint infection (PJI) diagnosis and pathogen identification. But the discordance between preoperative aspiration culture and intraoperative synovial fluid culture remains unknown. We aim to determine (1) the discordance between preoperative and intraoperative synovial fluid (SF) culture and. (2) compared to intraoperative synovial fluid cultures, the sensitivity of preoperative aspiration fluid culture. Then the following question is tried to be answered: Are intraoperative synovial fluid re-cultures necessary if the preoperative aspiration culture is positive? Materials and methods Between 2015 and 2019, 187 PJI patients managed with surgeries were included in this study. Compared to intraoperative synovial fluid culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative aspiration culture were calculated. Then, the discordance between preoperative aspiration culture and intraoperative SF culture was analyzed. Results The sensitivity of preoperative aspiration culture was 81.29% compared to intraoperative synovial fluid cultures. Concordance was identified in 147 PJI (78.61%) patients and culture discordance occurred in 40 patients (21.39%). In these discordant PJI patients, 24 patients (60%) were polymicrobial and no intraoperative synovial fluid culture growth was found in 16 PJI cases (40%). Preoperative monomicrobial staphylococcus results had a sensitivity of and a specificity of 80.43% and 83.16%, respectively. Preoperative polymicrobial results had the lowest sensitivity. Conclusions The intraoperative synovial fluid re-cultures are necessary if the preoperative aspiration culture is positive and the discordance between preoperative aspiration culture and intraoperative synovial fluid culture should be noted especially when Streptococcus spp. and more than one pathogen was revealed by preoperative aspiration culture. Level of evidence: Level III.

Performance of automated multiplex polymerase chain reaction (mPCR) using synovial fluid in the diagnosis of native joint septic arthritis in adults

2019 ◽  
Vol 101-B (3) ◽  
pp. 288-296 ◽  
Author(s):  
I. K. Sigmund ◽  
J. Holinka ◽  
F. Sevelda ◽  
K. Staats ◽  
S. Heisinger ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Synovial Fluid ◽  
Septic Arthritis ◽  
Multiplex Polymerase Chain Reaction ◽  
Microbiological Analysis ◽  
Chain Reaction ◽  
Cutibacterium Acnes ◽  
Polymerase Chain ◽  
Synovial Fluid Culture ◽  
Fluid Culture

Aims This study aimed to assess the performance of an automated multiplex polymerase chain reaction (mPCR) technique for rapid diagnosis of native joint septic arthritis Patients and Methods Consecutive patients with suspected septic arthritis undergoing aseptic diagnostic joint aspiration were included. The aspirate was used for analysis by mPCR and conventional microbiological analysis. A joint was classed as septic according to modified Newman criteria. Based on receiver operating characteristic (ROC) analysis, the area under the ROC curve (AUC) values of the mPCR and the synovial fluid culture were compared using the z-test. A total of 72 out of 76 consecutive patients (33 women, 39 men; mean age 64 years (22 to 92)) with suspected septic arthritis were included in this study. Results Of 72 patients, 42 (58%) were deemed to have septic joints. The sensitivity of mPCR and synovial fluid culture was 38% and 29%, respectively. No significant differences were found between the AUCs of both techniques (p = 0.138). A strong concordance of 89% (Cohen’s kappa: 0.65) was shown. The mPCR failed to detect Staphylococcus aureus (n = 1) and Streptococcus pneumoniae (n = 1; no primer included in the mPCR), whereas the synovial fluid culture missed six microorganisms (positive mPCR: S. aureus (n = 2), Cutibacterium acnes (n = 3), coagulase-negative staphylococci (n = 2)). Conclusion The automated mPCR showed at least a similar performance to the synovial fluid culture (the current benchmark) in diagnosing septic arthritis, having the great advantage of a shorter turnaround time (within five hours). Cite this article: Bone Joint J 2019;101-B:288–296.

scholarly journals Preoperative synovial fluid culture poorly predicts the pathogen causing periprosthetic joint infection

Infection ◽  
2020 ◽  
Author(s):  
Philipp Schulz ◽  
Constantin E. Dlaska ◽  
Carsten Perka ◽  
Andrej Trampuz ◽  
Nora Renz
Keyword(s):  
Synovial Fluid ◽  
Periprosthetic Joint Infection ◽  
Detection Rate ◽  
Pathogen Detection ◽  
Joint Infection ◽  
Coagulase Negative Staphylococci ◽  
Exact Test ◽  
Culture Positive ◽  
Synovial Fluid Culture ◽  
Polymicrobial Infections

Abstract Purpose We investigated the value of preoperative pathogen detection and evaluated its concordance with intraoperative cultures in patients with culture-positive periprosthetic joint infection (PJI). Methods Culture-positive PJI episodes with available preoperative (synovial fluid) and intraoperative cultures (periprosthetic tissue, synovial or sonication fluid) were analyzed. The pathogen detection rate in preoperative and intraoperative cultures was compared using Fisher’s exact test and their concordance was calculated. Results Among 167 included PJI episodes, 150 were monomicrobial with coagulase-negative staphylococci (n = 55, 37%), S. aureus (n = 34, 23%), and streptococci (n = 21, 14%) being the most common pathogens. Seventeen episodes (10%) were polymicrobial infections. The pathogen(s) grew in preoperative culture in 110 and in intraoperative cultures in 153 episodes (66% vs. 92%, p < 0.001). The pathogen detection rate was lower in preoperative compared to intraoperative cultures for low-virulent pathogens (40% vs. 94%, p < 0.001), polymicrobial infections (59% vs. 100%, p = 0.007), and in delayed and late PJI (63% vs. 94%, and 66% vs. 91%, respectively, p < 0.001). Full concordance of preoperative and intraoperative cultures was found in 87 episodes (52%). The pathogen was detected solely preoperatively in 14 episodes (8%) and solely intraoperatively in 57 cases (34%); an additional pathogen was found in 3 episodes (2%) preoperatively and in 6 episodes (4%) intraoperatively. Conclusion The concordance of preoperative and intraoperative cultures was poor (52%). The sole or an additional pathogen was found exclusively in intraoperative cultures in 38% of PJI episodes, hence preoperative synovial fluid cultures are considered unreliable for pathogen detection in PJI.

scholarly journals Evaluation of a rapid lateral flow calprotectin test for the diagnosis of prosthetic joint infection

2019 ◽  
Author(s):  
Alexander J. Trotter ◽  
Rachael Dean ◽  
Celia E. Whitehouse ◽  
Jarle Mikalsen ◽  
Claire Hill ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Sensitivity And Specificity ◽  
Prosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Lateral Flow ◽  
Lateral Flow Assay ◽  
Prosthetic Joint ◽  
Flow Test ◽  
Lateral Flow Test

AbstractBackgroundMicrobiological diagnosis of prosthetic joint infection (PJI) relies on culture techniques that are slow and insensitive. Rapid tests are urgently required to improve patient management. Calprotectin is a neutrophil biomarker of inflammation that has been demonstrated to be effective for the diagnosis of PJI. A calprotectin based lateral flow test has been developed for the rapid detection of PJI using synovial fluid samples.MethodsA convenience series of 69 synovial fluid samples from patients at the Norfolk and Norwich University Hospitals (NNUH) were collected intraoperatively from 52 hip and 17 knee revision operations. Calprotectin levels were measured using a new commercially available lateral flow assay for PJI diagnosis (Lyfstone). For all samples, synovial fluid was pipetted onto the lateral flow device and the signal was read using a mobile phone app after 15 minutes incubation at room temperature.ResultsAccording to the Musculoskeletal Infection Society (MSIS) criteria, 24 patients were defined as PJI positive and the remaining 45 were negative. The overall accuracy of the lateral flow test against the MSIS criteria was 75%. The test had a sensitivity and specificity of 75% and 76% respectively with a positive predictive value (PPV) of 62% and a negative predictive value (NPV) of 85%. Discordant results were then reviewed by the clinical team using available patient data to develop an alternative gold standard for defining presence/absence of infection (MSIS+). Compared to MSIS+, the test showed an overall accuracy of 83%, sensitivity and specificity of 95% and 78% respectively, a PPV of 62% and an NPV of 98%. Test accuracy for hip revisions was 77% and for knee revisions was 100%.ConclusionsThis study demonstrates that the calprotectin lateral flow assay is an effective diagnostic test for PJI. Our data suggests that the test is likely to generate false positive results in patients with metallosis and gross osteolysis.

scholarly journals The value of calprotectin in synovial fluid for the diagnosis of chronic prosthetic joint infection

2020 ◽  
Vol 9 (8) ◽  
pp. 450-456
Author(s):  
Zeyu Zhang ◽  
Yuanqing Cai ◽  
Guochang Bai ◽  
Chaofan Zhang ◽  
Wenbo Li ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Sensitivity And Specificity ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
White Blood Cells ◽  
Area Under The Curve ◽  
Enzyme Linked Immunosorbent Assay ◽  
Polymorphonuclear Cells ◽  
Diagnostic Efficacy ◽  
Prosthetic Joint

Aims This study aimed to evaluate calprotectin in synovial fluid for diagnosing chronic prosthetic joint infection (PJI) . Methods A total of 63 patients who were suspected of PJI were enrolled. The synovial fluid calprotectin was tested by an enzyme-linked immunosorbent assay (ELISA). Laboratory test data, such as ESR, CRP, synovial fluid white blood cells (SF-WBCs), and synovial fluid polymorphonuclear cells (SF-PMNs), were documented. Chi-squared tests were used to compare the sensitivity and specificity of calprotectin and laboratory tests. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated to determine diagnostic efficacy. Results The median calprotectin level was 776 μg/ml (interquartile range (IQR) 536.5 to 1132) in the PJI group and 54.5 μg/ml (IQR, 38.75 to 78.25) in the aseptic failure (AF) group (p < 0.05). Using a threshold of 173 ug/ml, the sensitivity was 95.2%, with a 97.6% specificity, and the AUC was 0.993. The sensitivity of calprotectin of the antibiotic-treated PJI group was 100% versus 90.9% of the non-antibiotic-treated PJI group. Although 47.6% (ten cases) of the patients in the PJI group received antibiotics before aspiration, the diagnostic efficacy of calprotectin was not affected. The sensitivity and specificity of ESR, CRP, SF-WBCs, and SF-PMNs ranged from 76.2% to 90.5% and 64.3% to 85.7%, respectively. Conclusion Calprotectin in synovial fluid has great diagnostic efficacy for PJI diagnosisand outperformed ESR, CRP, SF-WBCs, and SF-PMNs. Cite this article: Bone Joint Res 2020;9(8):450–456.

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