Assessment of a Multiplex Serological Test for the Diagnosis of Prosthetic Joint Infection: a Prospective Multicentre Study

Abstract

Introduction:The diagnosis of prosthetic joint infections (PJIs) can be difficult in the chronic stage and is based on clinical and paraclinical evidence. A minimally invasive serological test against the main pathogens encountered during PJI would distinguish PJI from mechanical loosening. Methods: We performed a prospective, multicentre, cross-sectional study to assess the contribution of serology in the diagnosis of PJI. Over a 2-year period, all patients undergoing prosthesis revision were included in the study. A C-reactive protein assay and a serological test specifically designed against 5 bacterial species (Staphylococcus aureus, S. epidermidis, S. lugdunensis, Streptococcus agalactiae, Cutibacterium acnes) were performed preoperatively. Five samples per patient were taken intraoperatively during surgery. The diagnosis of PJI was based on clinical and bacteriological criteria according to guidelines. Results: Between November 2015 and November 2017, 115 patients were included, 49 for a chronic PJI and 66 for a mechanical problem. Among patients with PJI, a sinus tract was observed in 32.6% and a C-reactive protein level ≥10 mg/L in 74.5%. The PJI was monomicrobial in 43 cases (targeted staphylococci, 24; S. agalactiae, 1; C. acnes, 2; others, 16), and polymicrobial in 6 cases (12.2%). Sensitivity, specificity, positive predictive value and negative predictive value were 75.0%, 82.1%, 58.3% and 90.8%, respectively, for targeted staphylococci. Specificity/negative predictive value was 97.3%/100% for S. agalactiae and 83.8% /96.9% for C. acnes. Conclusions: The serological tests are insufficient to affirm the diagnosis of PJI for the targeted bacteria. Nevertheless, the excellent NPV may help clinicians to exclude PJI.

Increased Diagnostic Certainty of Periprosthetic Joint Infections by Combining Microbiological Results with Histopathological Samples Gained via a Minimally Invasive Punching Technique

“…In addition to microbiological cultural bound analyses, the synovial fluid can be examined for cell count or synovial fluid biomarkers [ 7 ] and microbiological multiplex polymerase chain reaction (PCR) approaches. The latter technique allows for rapid pathogen detection, also in combination with the detection of selected molecular antibiotic resistance markers [ 8 , 9 ]. In addition to microbiological analyses, the diagnosis of an infection can be fostered by histopathological examinations from parts of periprosthetic membranes as mentioned before [ 10 , 11 ].…”

Risk factors of reinfection after prosthesis removal and antibiotic bone cement spacer implantation for the treatment of periprosthetic joint infection

“…Some patients with periprosthetic infection will have typical clinical manifestations of the sinus tract, and it has been shown that nearly one-third of patients with periprosthetic infection will develop sinus tracts [ 25 , 26 ]. The sinus tract, as the main standard, plays an important role in the diagnosis of periprosthetic infection, while the therapeutic effect of the sinus tract on periprosthetic infection is also worthy of attention.…”

Clinical utilization of species‐specific immunoassays for identification of Staphylococcus aureus and Streptococcus agalactiae in orthopedic infections

“…However, their immunoassay utilized only serum samples and was confined to PJI only. Other multiplex serological tests have proven to be insufficient for GBS diagnosis of PJI 36. Since antibody-secreting cells are indicative of an active infection, MENSA immunoassay is a promising method for tracking antibiotic treatment response and detecting recurrent infection 17.…”