Diagnosis of Periprosthetic Infection

Wasterlain, Amy S.; Goswami, Karan; Ghasemi, S. Ali; Parvızı, Javad

doi:10.2106/jbjs.19.00598

Cited by 22 publications

(16 citation statements)

References 93 publications

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“…Our findings highlight the potential of NMR-based metabolomics as a viable tool for diagnosis and identification of new targets for prevention and control of P. aeruginosa infection and biofilm. Detection of certain types of infections, such as periprosthetic joint infection, is difficult and requires time-consuming culturing methods, making early and pathogen-specific intervention unfeasible in many cases and there are no clinical biomarkers for the presence of biofilms ( Glaudemans et al., 2019 ; Wasterlain et al., 2020 ). As a highly reproducible and quantitative method, NMR spectroscopy has the potential to identify metabolite biomarkers or fingerprints of infection in bodily fluids such as serum and synovial fluid ( Hugle et al., 2012 ; Ammons et al., 2014 ; Palama et al., 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Cadaverine Is a Switch in the Lysine Degradation Pathway in Pseudomonas aeruginosa Biofilm Identified by Untargeted Metabolomics

Leggett

Sindeldecker

et al. 2022

Front. Cell. Infect. Microbiol.

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There is a critical need to accurately diagnose, prevent, and treat biofilms in humans. The biofilm forming P. aeruginosa bacteria can cause acute and chronic infections, which are difficult to treat due to their ability to evade host defenses along with an inherent antibiotic-tolerance. Using an untargeted NMR-based metabolomics approach, we identified statistically significant differences in 52 metabolites between P. aeruginosa grown in the planktonic and lawn biofilm states. Among them, the metabolites of the cadaverine branch of the lysine degradation pathway were systematically decreased in biofilm. Exogenous supplementation of cadaverine caused significantly increased planktonic growth, decreased biofilm accumulation by 49% and led to altered biofilm morphology, converting to a pellicle biofilm at the air-liquid interface. Our findings show how metabolic pathway differences directly affect the growth mode in P. aeruginosa and could support interventional strategies to control biofilm formation.

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Section: Discussionmentioning

confidence: 99%

Cadaverine Is a Switch in the Lysine Degradation Pathway in Pseudomonas aeruginosa Biofilm Identified by Untargeted Metabolomics

Leggett

Sindeldecker

et al. 2022

Front. Cell. Infect. Microbiol.

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“…Calprotectin from synovial fluid has been regarded as a promising test for diagnosis according to many studies [ 25 , 35 ]. M. Wouthuyzen-Bakker et al conducted a first study on diagnostic value of synovial calprotectin that a cutoff value of 50 mg/L has high sensitivity (89%) and specificity (90%), with a NPV of 97%.…”

Section: Discussionmentioning

confidence: 99%

Synovial calprotectin for the diagnosis of periprosthetic joint infection: a diagnostic meta-analysis

et al. 2022

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Background Periprosthetic joint infections (PJI) are a rare but severe complication of total joint arthroplasty (TJA). However, the diagnosis of PJI remains difficult. It is one of the research that focuses about diagnosis for PJI for majority researchers to discover a novel biomarker. This meta-analysis tried to evaluate diagnostic value of synovial calprotectin for PJI. Methods This meta-analysis search of the literature was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library. Literature quality was appraised using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) based on RevMan (version 5.3). The diagnostic value of calprotectin for PJI was evaluated by calculating sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), diagnostic score and area under SROC (AUC) based on the Stata version 14.0 software. We conduct subgroup analysis according to the study design, cutoff values, the country of study, and gold standard. Results Seven studies were included in this meta-analysis. The pooled sensitivity of synovial calprotectin for the diagnosis of PJI was 0.94 (95% CI, 0.87–0.98), and the specificity was 0.93 (95% CI, 0.87–0.96). The pooled AUC, PLR, and NLR for synovial calprotectin were 0.98 (95% CI, 0.96–0.99), 13.65 (95% CI, 6.89–27.07), and 0.06 (95% CI, 0.02–0.15), respectively. The pooled diagnostic score and DOR were 5.4 (95% CI, 3.96–6.85) and 222.32 (95% CI, 52.52–941.12), respectively. Conclusion In summary, this meta-analysis indicates that synovial calprotectin is a promising biomarker of assistant diagnosis for PJI, as well as recommended test for excluding diagnostic tool.

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“…the current accepted preoperative diagnostic reference standard test is the 2018 ICM modification of the MSIS criteria, with a reported sensitivity of 99.7% and specificity of 99.5%. 46 accurate diagnosis and exclusion of PJi is essential, as it changes the treatment algorithm. if an uninfected arthroplasty patient is misdiagnosed as PJi, the patient is at risk of morbidity from any exploratory or revision surgery.…”

Section: Discussionmentioning

confidence: 99%

Synovial fluid calprotectin performs better than synovial fluid polymerase chain reaction and interleukin-6 in the diagnosis of periprosthetic joint infection

Cheok

Smith

Siddiquee

et al. 2022

The Bone & Joint Journal

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Aims The preoperative diagnosis of periprosthetic joint infection (PJI) remains a challenge due to a lack of biomarkers that are both sensitive and specific. We investigated the performance characteristics of polymerase chain reaction (PCR), interleukin-6 (IL6), and calprotectin of synovial fluid in the diagnosis of PJI. Methods We performed systematic search of PubMed, Embase, The Cochrane Library, Web of Science, and Science Direct from the date of inception of each database through to 31 May 2021. Studies which described the diagnostic accuracy of synovial fluid PCR, IL6, and calprotectin using the Musculoskeletal Infection Society criteria as the reference standard were identified. Results Overall, 31 studies were identified: 20 described PCR, six described IL6, and five calprotectin. The sensitivity and specificity were 0.78 (95% confidence interval (CI) 0.67 to 0.86) and 0.97 (95% CI 0.94 to 0.99), respectively, for synovial PCR;, 0.86 (95% CI 0.74 to 0.92), and 0.94 (95% CI 0.90 to 0.96), respectively, for synovial IL6; and 0.94 (95% CI 0.82 to 0.98) and 0.93 (95% CI 0.85 to 0.97), respectively, for synovial calprotectin. Likelihood ratio scattergram analyses recommended clinical utility of synovial fluid PCR and IL6 as a confirmatory test only. Synovial calprotectin had utility in the exclusion and confirmation of PJI. Conclusion Synovial fluid PCR and IL6 had low sensitivity and high specificity in the diagnosis of PJI, and is recommended to be used as confirmatory test. In contrast, synovial fluid calprotectin had both high sensitivity and specificity with utility in both the exclusion and confirmation of PJI. We recommend use of synovial fluid calprotectin studies in the preoperative workup of PJI. Cite this article: Bone Joint J 2022;104-B(3):311–320.

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Diagnosis of Periprosthetic Infection

Cited by 22 publications

References 93 publications

Cadaverine Is a Switch in the Lysine Degradation Pathway in Pseudomonas aeruginosa Biofilm Identified by Untargeted Metabolomics

Cadaverine Is a Switch in the Lysine Degradation Pathway in Pseudomonas aeruginosa Biofilm Identified by Untargeted Metabolomics

Synovial calprotectin for the diagnosis of periprosthetic joint infection: a diagnostic meta-analysis

Synovial fluid calprotectin performs better than synovial fluid polymerase chain reaction and interleukin-6 in the diagnosis of periprosthetic joint infection

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