Camille de Seynes1,2, Bertille de Barbeyrac3,2, Hervé Dutronc1,2, Clément Ribes4,2, Paul Crémer4,2, Véronique Dubois3,2, Thierry Fabre4,2, Michel Dupon1,2, Frédéric-Antoine Dauchy1,2. 1. a Department of Infectious and Tropical Diseases , Hôspital Pellegrin, CHU de Bordeaux , Bordeaux , France. 2. d Centre de Référence Infections Ostéo-Articulaires Complexes du Grand Sud-Ouest (Crioac GSO) , Hôspital Pellegrin, CHU de Bordeaux , Bordeaux , France. 3. b Laboratory of Microbiology , Hôspital Pellegrin, CHU de Bordeaux , Bordeaux , France. 4. c Department of Orthopaedic Surgery , Hôspital Pellegrin, CHU de Bordeaux , Bordeaux , France.
Abstract
BACKGROUND: Prosthetic joint infection (PJI) is a severe complication of orthopaedic surgery. Preoperative diagnosis, although sometimes difficult, is key to choose the relevant treatment. METHODS: We conducted a prospective study aimed at evaluating the diagnostic performance of a multiplex serological test for the pre-operative diagnosis of PJI. Blood samples were collected between 1 July 2016 and 31 July 2017 among patients referred for suspected PJI that occurred at least six weeks prior. Infection diagnosis was confirmed using intraoperative bacteriological cultures during prosthetic exchange. RESULTS: Seventy-one patients were included, with a median age of 73 years (interquartile range [IQR]: 66-81) and 40 (56%) were male. Twenty-six patients had aseptic loosening and 45 patients had PJI. Among the latter, median time since the last surgery was 96 weeks (IQR: 20-324). Intraoperative cultures found Staphylococcus spp, Streptococcus spp or both in 39, 5 and 1 patients, respectively. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 81.8, 95.4, 97.3 and 72.4%, respectively, for all patients and 87.5, 93.5, 94.6 and 85.3%, respectively, for staphylococcal infections. Patients with false negative (FN) results had a significantly lower blood lymphocyte count (p = .045). CONCLUSIONS: Multiplex serological test performed well among patients with chronic staphylococcal prosthetic infection. This approach could contribute to PJI diagnosis especially in patients for whom the pre-operative analysis of joint fluid is not informative.
BACKGROUND: Prosthetic joint infection (PJI) is a severe complication of orthopaedic surgery. Preoperative diagnosis, although sometimes difficult, is key to choose the relevant treatment. METHODS: We conducted a prospective study aimed at evaluating the diagnostic performance of a multiplex serological test for the pre-operative diagnosis of PJI. Blood samples were collected between 1 July 2016 and 31 July 2017 among patients referred for suspected PJI that occurred at least six weeks prior. Infection diagnosis was confirmed using intraoperative bacteriological cultures during prosthetic exchange. RESULTS: Seventy-one patients were included, with a median age of 73 years (interquartile range [IQR]: 66-81) and 40 (56%) were male. Twenty-six patients had aseptic loosening and 45 patients had PJI. Among the latter, median time since the last surgery was 96 weeks (IQR: 20-324). Intraoperative cultures found Staphylococcus spp, Streptococcus spp or both in 39, 5 and 1 patients, respectively. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 81.8, 95.4, 97.3 and 72.4%, respectively, for all patients and 87.5, 93.5, 94.6 and 85.3%, respectively, for staphylococcal infections. Patients with false negative (FN) results had a significantly lower blood lymphocyte count (p = .045). CONCLUSIONS: Multiplex serological test performed well among patients with chronic staphylococcal prosthetic infection. This approach could contribute to PJI diagnosis especially in patients for whom the pre-operative analysis of joint fluid is not informative.
Authors: Thomas Bauer; Simon Marmor; Idir Ghout; Elsa Salomon; Faten El Sayed; Beate Heym; Jacques Ropers; Martin Rottman; Jean-Louis Gaillard; Anne-Laure Roux Journal: Clin Orthop Relat Res Date: 2020-12 Impact factor: 4.755
Authors: Thomas Bauer; Simon Marmor; Idir Ghout; Elsa Salomon; Faten El Sayed; Beate Heym; Martin Rottman; Jean-Louis Gaillard; Anne-Laure Roux Journal: J Bone Jt Infect Date: 2019-09-26