Improving the accuracy of synovial fluid analysis in the diagnosis of prosthetic joint infection with simple and inexpensive biomarkers

Sousa, Ricardo; Serrano, P.; Dias, Joana Gomes; Oliveira, José Carlos; Oliveira, Ana

doi:10.1302/0301-620x.99b3.bjj-2016-0684.r1

Cited by 75 publications

(35 citation statements)

References 42 publications

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“…Sensitivity of CRP increased notably when cutoff was reduced from 10 to 7.0 mg/L, though maintaining similar specificity. This finding underlines the importance to standardize CRP analysis since a wide variability in cutoff values has been reported by Sousa et al 11 and Omar et al 12 …”

Section: Discussionsupporting

confidence: 59%

Alpha defensin, leukocyte esterase, C-reactive protein, and leukocyte count in synovial fluid for pre-operative diagnosis of periprosthetic infection

Vecchi

Romanò

Grandi

et al. 2018

Int J Immunopathol Pharmacol

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Synovial fluid analysis for diagnosis of prosthetic joint infections has gained increasing interest in the recent past when markers more specific for these infections than the serum ones have been identified. Despite the important steps forward, identification of a gold standard has not yet been identified. In this study, usefulness of alpha defensin, leukocyte esterase, C-reactive protein (CRP), and white blood cells (WBCs) in synovial fluids alone and in combination for diagnosis of prosthetic joint infection was evaluated. Synovial fluids from 32 infected and 34 not infected patients were analyzed. Sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and receiver-operating characteristic (ROC) curves were calculated for each parameter. Moreover, combination of coupled variables was also evaluated by logistic regression analysis. Sensitivity of alpha defensin, CRP, leukocyte count, and leukocyte esterase were 84.4%, 87.5%, 93.7%, and 93.8%, respectively. Specificity was 91.2% for leukocyte counts, 94.1% for alpha defensin, 97.0% for CRP, and 97.1% for leukocyte esterase. Diagnostic accuracy was 89.4% for alpha defensin, 92.4% for WBC counts and CRP, and 95.5% for leukocyte esterase. No statistical differences were observed in area under the curve (AUC) of the ROC curves of alpha defensin, CRP, and leukocyte counts. Logistic regression analysis applied to a model comprising all the variables showed an AUC higher than AUC of coupled variables. In conclusion, results of this study confirm the high sensitivity and specificity of synovial leukocyte esterase for diagnosis of prosthetic joint infection, also suggesting the need to assess a panel of markers to optimize diagnosis of these infections.

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Section: Discussionsupporting

confidence: 59%

Alpha defensin, leukocyte esterase, C-reactive protein, and leukocyte count in synovial fluid for pre-operative diagnosis of periprosthetic infection

Vecchi

Romanò

Grandi

et al. 2018

Int J Immunopathol Pharmacol

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“…Inflammation biomarkers such as fibrinogen, C-reactive protein, and leucocyte count did not correlate with eDNA levels of 24 hours biofilms of the respective pathogens. Yet, a significant difference between the clinical presentation of PJI caused by either S. aureus or S. epidermidis was found in our patient population likewise in earlier studies [ 29 , 30 ], where patients with PJI caused by S. aureus exhibited greater serum levels of C-reactive protein and fibrinogen compared to patients with PJI caused by S. epidermidis .…”

Section: Discussionsupporting

confidence: 73%

Bacterial Extracellular DNA Production Is Associated with Outcome of Prosthetic Joint Infections

Zatorska

Arciola

Haffner

et al. 2018

BioMed Research International

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In a retrospective study the association of the production of extracellular DNA (eDNA) in biofilms of clinical staphylococcal isolates from 60 patients with prosthetic joint infection (PJI) and the clinical outcome were investigated. Data from a previous study on eDNA production determined in 24-hour biofilms of staphylococcal isolates (Staphylococcus aureus n=30, Staphylococcus epidermidis n=30) was correlated with the patients' clinical outcome after 3 and 12 months. Statistical analysis was performed using either the Spearman's rank correlations test or the t-test. eDNA production of S. epidermidis in 24-hour biofilms correlated with the patients' outcome ‘not cured‘ after 12 months. For S. aureus no such correlation was detected. Thus, eDNA may be a virulence factor of S. epidermidis. Quantification of eDNA production as a surrogate marker for biofilm formation might be a potential predictive marker for the management of PJI.

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“…Rheumatoid disease and infection should be excluded from the diagnosis of patients with symptoms of KOA and so, clinically, synovial fluid, blood and serum markers play an important role in excluding knee joint infection [ 37 , 38 ]. Interleukin (IL)-1β) and tumor necrosis factors were considered to be the most important pro-inflammatory mediators in OA [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Selection and Investigation of a Primate Model of Spontaneous Degenerative Knee Osteoarthritis, the Cynomolgus Monkey (Macaca Fascicularis)

et al. 2018

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BackgroundThe aim of this study was to identify a primate model of degenerative knee osteoarthritis (KOA) that may be more relevant for research studies on degenerative KOA in humans.Material/MethodsSixteen specific-pathogen-free (SPF) male cynomolgus monkeys (Macaca fascicularis) were divided into group A (n=8), an old group (22.0–25.3 years of age), and group B (n=8), a young group (3.0–5.2 years of age). For each primate, the behavior was observed, knee circumference was measured, knee joint X-rays were performed, and peripheral blood white blood cell (WBC) counts were measured, and the Kellgren and Lawrence (K-L) system was used for the classification of osteoarthritis. An enzyme-linked immunoassay (ELISA) was performed on knee joint fluid to measure levels of interleukin (IL)-1β, transforming growth factor (TGF)-β1, and matrix metalloproteinase (MMP)13. Changes in articular cartilage were evaluated using the Brittberg score and the Mankin histopathology grading score, respectively. Quantitative reverse transcription polymerase chain reaction (RT-qPCR) and Western blot were used to measure the expression of the NOTCH3, JAG1, and ACAN genes in knee cartilage specimens, and the findings in the two groups of primates were compared.ResultsSeven old aged primates in group A were compared with group B, and showed significant differences in WBC count, synovial fluid IL-1β, TGF-β1, and MMP13 levels, expression levels of the NOTCH3, JAG1, and ACAN genes in knee cartilage specimens, and in the Brittberg and Mankin scores (all, P<0.05).ConclusionsCynomolgus monkeys (Macaca fascicularis) might be a model for age-related degenerative KOA.

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Improving the accuracy of synovial fluid analysis in the diagnosis of prosthetic joint infection with simple and inexpensive biomarkers

Cited by 75 publications

References 42 publications

Alpha defensin, leukocyte esterase, C-reactive protein, and leukocyte count in synovial fluid for pre-operative diagnosis of periprosthetic infection

Alpha defensin, leukocyte esterase, C-reactive protein, and leukocyte count in synovial fluid for pre-operative diagnosis of periprosthetic infection

Bacterial Extracellular DNA Production Is Associated with Outcome of Prosthetic Joint Infections

Selection and Investigation of a Primate Model of Spontaneous Degenerative Knee Osteoarthritis, the Cynomolgus Monkey (Macaca Fascicularis)

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