Katsiaryna Yermak1, Svetlana Karbysheva2, Carsten Perka1, Andrej Trampuz3, Nora Renz1. 1. Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, D-13353 Berlin, Germany. 2. Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, D-13353 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany. 3. Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, D-13353 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany. Electronic address: andrej.trampuz@charite.de.
Abstract
OBJECTIVES: Synovial fluid leukocyte count is the current standard test for diagnosing periprosthetic joint infection (PJI). As D-lactate is almost exclusively produced by bacteria, it represents a useful biomarker for bacterial infection. We evaluated the performance of synovial fluid D-lactate for the diagnosis of PJI and compared it with the synovial fluid leukocyte count. METHODS: Consecutive patients with joint aspiration of a prosthetic hip, knee or shoulder joint were prospectively included. PJI was diagnosed according to the working criteria of the European Bone and Joint Infection Society (EBJIS). The synovial fluid D-lactate was determined spectrophotometrically at 570 nm, synovial fluid leukocytes were counted by flow cytometry. The receiver operating characteristic (ROC) analysis was performed to assess the diagnostic performance of investigated parameters. RESULTS: Of 148 patients, 44 (30%) were diagnosed with PJI and 104 (70%) with aseptic failure. For diagnosis of PJI, the sensitivity of synovial fluid D-lactate (at cut-off 1.263 mmol/l) was 86.4% [95% CI, 75.0-95.5%] and the specificity was 80.8% [95% CI, 73.1-88.5%]. The AUCs of D-lactate concentration and leukocyte count were 90.3% [95% CI 85.7-95.0%] and 91.0% [95% CI 85.1-96.8%], respectively (p = 0.8). Virulence of the pathogen did not influence the D-lactate concentration (p = 0.123). The synovial fluid erythrocyte concentration correlated with D-lactate in patients with aseptic failure (ρ = 0.339, p <0.01). CONCLUSION: Synovial fluid D-lactate showed similar performance to the leukocyte count for diagnosis of PJI. Advantages of D-lactate test are requirement of low synovial fluid volume, short turnaround time and low cost.
OBJECTIVES: Synovial fluid leukocyte count is the current standard test for diagnosing periprosthetic joint infection (PJI). As D-lactate is almost exclusively produced by bacteria, it represents a useful biomarker for bacterial infection. We evaluated the performance of synovial fluid D-lactate for the diagnosis of PJI and compared it with the synovial fluid leukocyte count. METHODS: Consecutive patients with joint aspiration of a prosthetic hip, knee or shoulder joint were prospectively included. PJI was diagnosed according to the working criteria of the European Bone and Joint Infection Society (EBJIS). The synovial fluid D-lactate was determined spectrophotometrically at 570 nm, synovial fluid leukocytes were counted by flow cytometry. The receiver operating characteristic (ROC) analysis was performed to assess the diagnostic performance of investigated parameters. RESULTS: Of 148 patients, 44 (30%) were diagnosed with PJI and 104 (70%) with aseptic failure. For diagnosis of PJI, the sensitivity of synovial fluid D-lactate (at cut-off 1.263 mmol/l) was 86.4% [95% CI, 75.0-95.5%] and the specificity was 80.8% [95% CI, 73.1-88.5%]. The AUCs of D-lactate concentration and leukocyte count were 90.3% [95% CI 85.7-95.0%] and 91.0% [95% CI 85.1-96.8%], respectively (p = 0.8). Virulence of the pathogen did not influence the D-lactate concentration (p = 0.123). The synovial fluid erythrocyte concentration correlated with D-lactate in patients with aseptic failure (ρ = 0.339, p <0.01). CONCLUSION: Synovial fluid D-lactate showed similar performance to the leukocyte count for diagnosis of PJI. Advantages of D-lactate test are requirement of low synovial fluid volume, short turnaround time and low cost.
Authors: Martin McNally; Ricardo Sousa; Marjan Wouthuyzen-Bakker; Antonia F Chen; Alex Soriano; H Charles Vogely; Martin Clauss; Carlos A Higuera; Rihard Trebše Journal: Bone Joint J Date: 2021-01 Impact factor: 5.082
Authors: Cortney E Heim; Megan E Bosch; Kelsey J Yamada; Amy L Aldrich; Sujata S Chaudhari; David Klinkebiel; Casey M Gries; Abdulelah A Alqarzaee; Yixuan Li; Vinai C Thomas; Edward Seto; Adam R Karpf; Tammy Kielian Journal: Nat Microbiol Date: 2020-07-13 Impact factor: 17.745