α-Defensin as a predictor of periprosthetic shoulder infection

Frangiamore, Salvatore J.; Saleh, Anas; Grosso, Matthew J.; Kovac, Mario Farias; Higuera, Carlos A.; Iannotti, Joseph P.; Ricchetti, Eric T.

doi:10.1016/j.jse.2014.12.021

Cited by 130 publications

(74 citation statements)

References 35 publications

(69 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Frangiamore et al 28 . The dashed red lines indicate the pooled sensitivity or specificity estimate.…”

mentioning

confidence: 98%

“…here were 10 articles reporting 11 evaluations 13,14,17,18,[26][27][28][29][30][31] that contributed to our estimates of diagnostic accuracy for both tests. Six studies explored the diagnostic accuracy of alpha-defensin for PJI 13,17,[26][27][28]31 , while the remaining 5 studies explored the diagnostic accuracy of leukocyte esterase for PJI 14,17,18,29,30 .…”

mentioning

confidence: 99%

“…Six studies explored the diagnostic accuracy of alpha-defensin for PJI 13,17,[26][27][28]31 , while the remaining 5 studies explored the diagnostic accuracy of leukocyte esterase for PJI 14,17,18,29,30 . Study characteristics are summarized in Table III. All of the included studies were published within the last 5 years and originated from the U.S.…”

mentioning

confidence: 99%

“…Five studies on alpha-defensin included patients who had hip or knee arthroplasty 13,17,26,27,31 and 2 studies included patients who had shoulder arthroplasty 28,31 . When details were provided, the mean ages of patients in these studies ranged from 61 to 67 years and 43% to 48% were male.…”

mentioning

confidence: 99%

See 3 more Smart Citations

The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection

Wyatt

Beswick

Kunutsor

et al. 2016

The Journal of Bone and Joint Surgery

177

View full text Add to dashboard Cite

Background: Synovial biomarkers have recently been adopted as diagnostic tools for periprosthetic joint infection (PJI), but their utility is uncertain. The purpose of this systematic review and meta-analysis was to synthesize the evidence on the accuracy of the alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of PJI compared with the Musculoskeletal Infection Society diagnostic criteria. Methods: We performed a systematic review to identify diagnostic technique studies evaluating the accuracy of alpha-defensin or leukocyte esterase in the diagnosis of PJI. MEDLINE and Embase on Ovid, ACM, ADS, arXiv, CERN DS (Conseil Européen pour la Recherche Nucléaire Document Server), CrossRef DOI (Digital Object Identifier), DBLP (Digital Bibliography & Library Project), Espacenet, Google Scholar, Gutenberg, HighWire, IEEE Xplore (Institute of Electrical and Electronics Engineers digital library), INSPIRE, JSTOR (Journal Storage), OAlster (Open Archives Initiative Protocol for Metadata Harvesting), Open Content, Pubget, PubMed, and Web of Science were searched for appropriate studies indexed from inception until May 30, 2015, along with unpublished or gray literature. The classification of studies and data extraction were performed independently by 2 reviewers. Data extraction permitted meta-analysis of sensitivity and specificity with construction of receiver operating characteristic curves for each test. Results: We included 11 eligible studies. The pooled diagnostic sensitivity and specificity of alpha-defensin (6 studies) for PJI were 1.00 (95% confidence interval [CI], 0.82 to 1.00) and 0.96 (95% CI, 0.89 to 0.99), respectively. The area under the curve (AUC) for alpha-defensin and PJI was 0.99 (95% CI, 0.98 to 1.00). The pooled diagnostic sensitivity and specificity of leukocyte esterase (5 studies) for PJI were 0.81 (95% CI, 0.49 to 0.95) and 0.97 (95% CI, 0.82 to 0.99), respectively. The AUC for leukocyte esterase and PJI was 0.97 (95% CI, 0.95 to 0.98). There was substantial heterogeneity among studies for both diagnostic tests. Conclusions: The diagnostic accuracy for PJI was high for both tests. Given the limited number of studies and the large cost difference between the tests, more independent research on these tests is warranted. Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

show abstract

“…Frangiamore et al 28 . The dashed red lines indicate the pooled sensitivity or specificity estimate.…”

mentioning

confidence: 98%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection

Wyatt

Beswick

Kunutsor

et al. 2016

The Journal of Bone and Joint Surgery

177

View full text Add to dashboard Cite

show abstract

“…In another recent study on diagnostic utility in periprosthetic joint infection of the shoulder with indolent organisms, synovial fluid alpha-defensin demonstrated a sensitivity of 63% and a specificity of 95% with significantly increased levels in revision cases with P. acnes-positive cultures 14 .…”

mentioning

confidence: 98%

When Is a Positive Culture in Shoulder Surgery Not an Infection?

Hasan¹,

Ricchetti²

2015

The Journal of Bone and Joint Surgery

Self Cite

View full text Add to dashboard Cite

Propionibacterium acnes represents the most common pathogen in periprosthetic joint infections of the shoulder, accounting for up to 70% of positive culture results at the time of revision surgery 1 . This diagnosis can be elusive for several reasons. P. acnes is a commensal organism of low virulence that populates the dermal sebaceous glands about the shoulder 2 . Its clinical presentation is often insidious and delayed and is frequently characterized clinically by persistent shoulder pain and a paucity of cutaneous, systemic, or radiographic signs. Furthermore, the preoperative work-up has been characterized historically by poor sensitivity. Acute-phase serologic markers such as the erythrocyte sedimentation rate and C-reactive protein level are often normal in P. acnes infections and the organism can be difficult to culture, requiring long-duration culture holds in multiple culture media 3 for optimal culture yield. The usefulness of intraoperative frozen sections for aiding in the diagnosis of periprosthetic joint infections of the shoulder varies from one pathology laboratory to another, but has been inconsistent at best 4 .Because of the low virulence of P. acnes and the associated diagnostic delay and uncertainty, surgeons are often confronted with difficult treatment dilemmas at the time of revision surgery, such as determining whether or not a revision should be carried out in a staged fashion until a periprosthetic joint infection can be effectively ruled out. In addition, positive cultures at the time of revision surgery may represent a true periprosthetic joint infection but may also arise unexpectedly as a contaminant during specimen procurement and culture incubation.Mook et al. set out to determine the rate of positive culture growth from deep-tissue specimens obtained from patients undergoing open surgery of the glenohumeral joint as well as the demographic correlates of the culture results. One of the study strengths is the availability of a control group comprising cultures of sterile gauze sponge specimens. The authors found that male sex strongly correlated with positive P. acnes cultures, which is in keeping with previous studies 1,5 . The authors also found that two or more previous intra-articular corticosteroid injections correlated with positive P. acnes cultures, which is compelling, given the frequency with which these are performed prior to the consideration of prosthetic shoulder arthroplasty. However, the authors also acknowledged that post hoc analysis revealed that their study was underpowered to test this association.The most striking study finding is the 13% prevalence of positive culture growth from the control gauze specimens. In addition, 18% of patients without prior surgery had at least one positive culture, 93% of which were positive for P. acnes, despite standardized and meticulous sample procurement. Finally, the authors observed that cultures continued to grow out over time, suggesting a greater prevalence of contamination after fourteen days of incubation. Taken togethe...

show abstract