Detection of Periprosthetic Infections With Use of Ribosomal RNA-Based Polymerase Chain Reaction

Bergin, Patrick F.; Doppelt, Jason D.; Hamilton, William G.; Mirick, Gudrun E.; Jones, Angela E.; Sritulanondha, Supatra; Helm, J. M.; Tuan, Rocky S.

doi:10.2106/jbjs.i.00400

Cited by 108 publications

(83 citation statements)

References 29 publications

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“…techniques [8,25,30,31,35]) as well as developing novel methods for diagnosing infection (polymerase chain reaction techniques [1,6,18,24,26], sonication of implants [50], and analysis of circulating cytokines [7,9,13,47]). The more we learn about the histopathologic characteristics of infected versus uninfected joints, the better able we will be to identify clinically relevant characteristics of infections [28,37,[39][40][41].…”

Section: Clinical Orthopaedics and Related Research ® A Publication Omentioning

confidence: 99%

Mark B. Coventry Award: Synovial C-reactive Protein: A Prospective Evaluation of a Molecular Marker for Periprosthetic Knee Joint Infection

Parvızı

Jacovides

Adeli

et al. 2012

Clinical Orthopaedics &Amp; Related Research

100

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Background C-reactive protein (CRP) serum assays are a standard element of the diagnostic workup for periprosthetic joint infection (PJI). However, because CRP is a marker for systemic inflammation, this test is not specific to PJI. Questions/purposes Our purpose was to assess whether synovial fluid and serum assays alone could differentiate between infected and uninfected revision knee arthroplasties and to determine which of these methods had the greatest diagnostic accuracy. Methods We collected synovial fluid specimens from 66 patients undergoing revision total knee arthroplasty. Patients were judged uninfected or infected by standardized criteria. Synovial CRP levels were measured using an individual CRP assay (15 samples; 10 infected, five uninfected) and a multiplex immunoassay platform (59 samples; 25 infected, 34 uninfected). Results from preoperative standard serum CRP assays conducted were also collected (55 samples; 25 infected, 30 uninfected). Sensitivity, specificity, and receiver operating characteristic curve analyses were performed for each assay with a diagnosis of infection based on previously established criteria.Results Synovial CRP concentrations differed between infected and uninfected joints in the multiplex and serum analyses. The area under the curve was 0.84 for the individual assay, 0.91 for the multiplex assay, and 0.88 for the serum CRP assay. Sensitivity and specificity were 70.0% and 100.0% for the individual enzyme-linked immunosorbent assay, 84.0% and 97.1% for the multiplex assay, and 76.0% and 93.3% for the serum CRP assay. Conclusions An assay measuring CRP in synovial fluid may be more accurate in diagnosing PJI than the standard serum CRP assay. We believe such an assay holds promise as a new diagnostic marker for PJI.

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Section: Clinical Orthopaedics and Related Research ® A Publication Omentioning

confidence: 99%

Mark B. Coventry Award: Synovial C-reactive Protein: A Prospective Evaluation of a Molecular Marker for Periprosthetic Knee Joint Infection

Parvızı

Jacovides

Adeli

et al. 2012

Clinical Orthopaedics &Amp; Related Research

100

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“…Although evidence-based recommendations for standardizing the diagnosis exist [9,23,27], there is no gold standard for diagnosis [2,24,36]. Efforts are ongoing to elucidate novel methods for detecting PJI, such as sonication of implants [32], molecular techniques [1,4,19,20], and analysis of circulating cytokines [5,12,29]. However, many of these new diagnostic measures are costly, require special equipment, or are time-consuming and thus not readily available [2,24,36].…”

Section: Introductionmentioning

confidence: 99%

Is Synovial C-reactive Protein a Useful Marker for Periprosthetic Joint Infection?

Tetreault

Wetters

Moric

et al. 2014

Clin Orthop Relat Res

100

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Background Serum C-reactive protein (CRP) is a general marker of inflammation, and recent studies suggest that measurement of CRP in synovial fluid may be a more accurate method for diagnosing periprosthetic joint infection (PJI). Questions/purposes We aimed to (1) determine if there is a correlation between serum and synovial CRP values, (2) establish cutoff values for diagnosing infection based on serum and synovial CRP, and (3) compare the utility of measuring CRP in synovial fluid versus serum for the diagnosis of PJI using standard assay equipment available at most hospitals. Methods Between February 2011 and March 2012, we invited all 150 patients scheduled for revision TKA (84) or THA (66) to participate in this prospective study, of whom 100% agreed. Data ultimately were missing for 31 patients, leaving 60 patients undergoing revision TKA and 59 undergoing revision THA (71% and 89% of the original group, respectively) for whom CRP level was measured in serum and synovial fluid samples. Patients were deemed to have a PJI (32) or no infection (87) using Musculoskeletal Infection Society criteria. Serum and synovial CRP levels were assayed using the same immunospectrophotometer and the correlation coefficient was calculated. Receiver operating characteristic curve analyses were performed to compare utility in diagnosing PJI, which included area under the curve, diagnostic threshold, and test sensitivity, specificity, predictive values, and accuracy. In 22 of 150 patients (14.7%), synovial CRP could not be measured because the sample was too viscous or hemolyzed. Results In the analyzed 119 samples, there was a strong correlation (r = 0.76; p \ 0.001) between synovial and serum CRP. The area under the curve was 0.90 both for the synovial fluid (95% CI, 0.82-0.97) and serum (95% CI, 0.84-0.96) CRP assays. The diagnostic thresholds were 6.6 mg/L for synovial fluid and 11.2 mg/L for serum. Sensitivities, specificities, positive predictive value, negative predictive value, and accuracies were similar for synovial fluid and serum assays. Conclusions Although recent studies have suggested a superiority of synovial fluid CRP over serum CRP for the diagnosis of PJI, we found that measurement of CRP in synovial fluid rather than serum using readily available

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“…Unfortunately, the current tests do not have perfect sensitivity or specificity. Historically, intraoperative tissue cultures have been used as the gold standard, although they lack optimal sensitivity (range, 0.70 to 0.90) and specificity (range, 0.67 to 0.91) (4,13,(23)(24)(25)(26). Moreover, a recent meta-analysis reported the sensitivity and specificity of preoperative aspiration culture as 72% and 95%, respectively (5).…”

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confidence: 99%

Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

Zhai

Qin

et al. 2014

J Clin Microbiol

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bThis meta-analysis included 12 studies that evaluated sonication fluid cultures (SFC) for the diagnosis of prosthetic joint infection (PJI). The pooled sensitivity and specificity were 0.80 (95% confidence interval [CI], 0.74 to 0.84) and 0.95 (CI, 0.90 to 0.98), respectively. Subgroup analyses showed that a 14-day anaerobic culture may improve sensitivity, the use of centrifugation or vortexing may improve specificity, and the use of 400 to 500 ml of Ringer's solution for containers may improve sensitivity and specificity. The best SFC cutoff was >5 CFU. In conclusion, SFC has high sensitivity and very high specificity for diagnosing PJI. P rosthetic joint infection (PJI), which occurs in 1 to 12% of surgical cases, is a common catastrophic complication of joint replacement (1-3). Hence, distinguishing PJI from other causes of joint failure, such as metal allergy or aseptic loosening, is important (4). Several tests for diagnosing PJI, including laboratory tests, nuclear medicine detection, rapid molecular tests, histopathology, and microbiologic culture (5-7), have limited sensitivity and specificity, which impedes the differentiation of PJI from other prosthetic failures (3,4,8).Sonication fluid cultures (SFC), which use sonication to dislodge bacteria from the prosthetic surface, have shown promising improvements in sensitivity compared with that for traditional tissue cultures (9). However, the sensitivities (range, 0.67 to 0.91) and specificities (range, 0.72 to 1.0) among studies assessing the diagnostic value of SFC for PJI are inconsistent (9-21). The Infectious Diseases Society of America guidelines suggest a gap in the validation of the diagnostic value of SFC for PJI and request additional higher-level evidence (8). Therefore, we evaluated the detection validity of SFC for PJI to provide further evidence for its clinical use.We searched Medline, EMBASE, and OVID for articles published between January 1990 and August 2013, using the following medical subject headings or free-text words: joint prosthesis, prosthesis infection, septic loosening, aseptic loosening, replacement, or arthroplasty; and sonication, sonicate, or ultrasonicate. We also manually searched the reference lists of eligible studies

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Detection of Periprosthetic Infections With Use of Ribosomal RNA-Based Polymerase Chain Reaction

Cited by 108 publications

References 29 publications

Mark B. Coventry Award: Synovial C-reactive Protein: A Prospective Evaluation of a Molecular Marker for Periprosthetic Knee Joint Infection

Mark B. Coventry Award: Synovial C-reactive Protein: A Prospective Evaluation of a Molecular Marker for Periprosthetic Knee Joint Infection

Is Synovial C-reactive Protein a Useful Marker for Periprosthetic Joint Infection?

Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

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