New Methods in the Diagnosis of Prosthetic Joint Infection

Cover Page

Abstract

A timely and accurate diagnosis of periprosthetic joint infection (PJI) is crucial to plan adequate treatment. Purpose of the study. To evaluate the performance of new diagnostic tests for the diagnosis of PJI. Material and Methods. The performance of novel biomarkers in synovial fluid (i.e. D-lactate and alfa-defensin), molecular test (i.e. PCR of synovial fluid and sonication fluid), new methods to dislodge biofilm from implant surface (i.e. MicroDTTect) and sonication of explanted prosthesis were investigated in patients with PJI and aseptic loosening of the prosthesis. Results. D-lactate showed better sensitivity for the diagnosis of PJI compared to leukocyte count (86% and 80%, respectively). The optimal D-lactate cut-off value was calculated at 1.26 mmol/l. The ADLF test showed sensitivity of 84%, 67% and to 54% depending on classification criteria used for the diagnosis of PJI (Musculoskeletal Infection Society (MSIS), The Infectious Diseases Society of America (IDSA) and proposed European Bone and Joint Infection Society (EBJIS) criteria, respectively). Using the proposed EBJIS definition criteria, the sensitivity of the leukocyte count was significantly higher than that of the ADLF test (86% compared with 54%; p<0,001), particularly in chronic PJI (81% compared with 44%, respectively; p<0,001). The sensitivity of synovial fluid PCR was 60% and herewith comparable with synovial fluid culture (52%, p = 0,239). The sensitivity and specificity of sonication fluid culture were 58% and 100%, which was comparable to sonication fluid PCR 51% and 94%, respectively. DTT-based method showed low sensitivity for diagnosis of PJI (40%) compared to sonication (80%, p<0,01). Conclusion. Synovial fluid D-lactate demonstrated good analytical performance and diagnostic value for the diagnosis of PJI. In particular, the high sensitivity for diagnosing infection and rapid availability of the test result make synovial fluid D-lactate suitable as screening test, whereas ADLF had limited sensitivity (54%) but high specificity (>95%) and it should therefore not be used for screening, but rather as a confirmatory test for PJI. Multiplex PCR of synovial fluid and sonication fluid has similar sensitivity and specificity compared to synovial fluid culture, having the advantage of rapid availability of results (within 5 hours) and fully automated process. With further improvement of its performance and inclusion of additional primers, multiplex PCR may complement conventional cultures, especially for rapid and accurate diagnosis of low-grade PJI. Culture of samples obtained by sonication of prostheses showed better sensitivity for the microbiologic diagnosis of prosthetic hip and knee infection compared to chemical based dislodgement such as MicroDTTect.

About the authors

S. Karbysheva

Center for Septic Surgery, Charité — University Medicine Berlin

Author for correspondence.
Email: svetlana.karbysheva@charite.de

Svetlana Karbysheva — Clinical Microbiologist

Berlin

Germany

N. Renz

Center for Septic Surgery, Charité — University Medicine Berlin

Email: fake@neicon.ru

Nora Renz — Infection Disease Specialist

Berlin

Germany

K. Yermak

Center for Septic Surgery, Charité — University Medicine Berlin

Email: fake@neicon.ru

Katsiaryna Yermak — Research Fellow

Berlin

Germany

S. Cabric

Center for Septic Surgery, Charité — University Medicine Berlin

Email: fake@neicon.ru

Sabrina Cabric — Research Fellow

Berlin

Germany

A. Trampuz

Center for Septic Surgery, Charité — University Medicine Berlin

Email: fake@neicon.ru

Trampuz Andrej — Head; Research Group Leader of the Biofilm Research Laboratory

Berlin

Germany

References

  1. Kaandorp C.J., Dinant H.J., van de Laar M.A., Moens H.J., Prins A.P., Dijkmans B.A. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis. 1997;56(8):470-475. doi: 10.1136/ard.56.8.470.
  2. Portillo M.E., Salvadó M., Alier A., Sorli L., Martínez S., Horcajada J.P., Puig L. Prosthesis failure within 2 years of implantation is highly predictive of infection. Clin Orthop Relat Res. 2013;471(11):3672-3678. doi: 10.1007/s11999-013-3200-7.
  3. Corvec S., Portillo M.E., Pasticci B.M., Borens O., Trampuz A. Epidemiology and new developments in the diagnosis of prosthetic joint infection. Int J Artif Organs. 2012;35(10):923-934. doi: 10.5301/ijao.5000168.
  4. Winkler T., Trampuz A., Renz N., Perka C., Bozhkova S. [Classification and algorithm for diagnosis and treatment of hip prosthetic joint infection]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2016;(1):21-32. (In Russian).
  5. Berbari E.F., Marculescu C., Sia I., Lahr B.D., Hanssen A.D., Steckelberg J.M. et al. Culture-negative prosthetic joint infection. Clin Infect Dis. 2007;45(9):1113-1119. doi: 10.1086/522184.
  6. Abdullah S., Young-Min S.A., Hudson S.J., Kelly C.A., Heycock C.R., Hamilton J.D. Gross synovial fluid analysis in the differential diagnosis of joint effusion. J Clin Pathol. 2007;60(10):1144-1147.
  7. Sharff K.A., Richards E.P., Townes J.M. Clinical management of septic arthritis. Curr Rheumatol Rep. 2013;15(6):332. doi: 10.1007/s11926-013-0332-4.
  8. Karbysheva S.B., Grigoricheva L.G., Zhyltsov I.V., Semenov V.M., Zolovkina A.G., Veremei I.S., Trampuz A. [Synovial Fluid D-lactate — Bacterial-Specific Marker for Infection of Native and Prosthetic Joints]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2017;23(2):6-14. (In Russian). doi: 10.21823/2311-2905-2017-23-2-6-14.
  9. Gratacos J., Vila J., Moya F., Marcos M.A., Collado A., Sanmarti R. et al. D-lactic acid in synovial fluid. A rapid diagnostic test for bacterial synovitis. J Rheumatol. 1995;22:1504-1508.
  10. Yermak K., Karbysheva S., Perka C., Trampuz A., Renz N. Performance of synovial fluid D-lactate for the diagnosis of periprosthetic joint infection: A prospective observational study. J Infect. 2019;79(2):123-129. doi: 10.1016/j.jinf.2019.05.015.
  11. Holinka J., Bauer L., Hirschl A.M., Graninger W., Windhager R., Presterl E. Sonication cultures of explanted components as an add-on test to routinely conducted microbiological diagnostics improve pathogen detection. J Orthop Res. 2011;29(4):617-622. doi: 10.1002/jor.21286.
  12. Zimmerli W., Trampuz A. Implant-Associated Infection. In: Bjarnsholt T., Jensen P.Ø., Moser C., Høiby N., ed. Biofilm Infections. NY: Springer New York; 2011:69-90.
  13. Kobayashi H., Oethinger M., Tuohy M.J., Procop G.W., Bauer T.W. Improved detection of biofilm-formative bacteria by vortexing and sonication: a pilot study. Clin Orthop Relat Res. 2009;467(5):1360-1364. doi: 10.1007/s11999-008-0609-5.
  14. Scheijen J.L., Hanssen N.M., van de Waarenburg M.P., Jonkers D.M., Stehouwer C.D., Schalkwijk C.G. L(+) and D(-) lactate are increased in plasma and urine samples of type 2 diabetes as measured by a simultaneous quantification of L(+) and D(-) lactate by reversed-phase liquid chromatography tandem mass spectrometry. Exp Diabetes Res. 2012;2012:234812. doi: 10.1155/2012/234812.
  15. Kasparek M.F., Kasparek M., Boettner F., Faschingbauer M., Hahne J., Dominkus M. Intraoperative Diagnosis of Periprosthetic Joint Infection Using a Novel Alpha-Defensin Lateral Flow Assay. J Arthroplasty. 2016;31(12):2871-2874. doi: 10.1016/j.arth.2016.05.033.
  16. Parvizi J., Gehrke T.; International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection. J Arthroplasty. 2014;29(7):1331. doi: 10.1016/j.arth.2014.03.009.
  17. Parvizi J., Gehrke T., Chen A.F. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J. 2013;95-B(11):1450-1452. doi: 10.1302/0301-620X.95B11.33135.
  18. Parvizi J., Tan T.L., Goswami K., Higuera C., Della Valle C., Chen A.F., Shohat N. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty. 2018;33(5):1309-1314.e2. doi: 10.1016/j.arth.2018.02.078.
  19. Parvizi J., Zmistowski B., Berbari E.F., Bauer T.W., Springer B.D., Della Valle C.J. et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469(11):2992-2994. doi: 10.1007/s11999-011-2102-9.
  20. Sigmund I.K., Holinka J., Gamper J., Staats K., Böhler C., Kubista B., Windhager R. Qualitative α-defensin test (Synovasure) for the diagnosis of periprosthetic infection in revision total joint arthroplasty. Bone Joint J. 2017;99-B(1):66-72. doi: 10.1302/0301-620X.99B1.BJJ-2016-0295.R1.
  21. Hall-Stoodley L., Costerton J.W., Stoodley P. Bacterial biofilms: from the natural environment to infectious diseases. Nat Rev Microbiol. 2004;2(2):95-108. doi: 10.1038/nrmicro821.
  22. Portillo M.E., Salvadó M., Alier A., Martínez S., Sorli L., Horcajada J.P., Puig L. Advantages of sonication fluid culture for the diagnosis of prosthetic joint infection. J Infect. 2014;69(1):35-41. doi: 10.1016/j.jinf.2014.03.002.
  23. Portillo M.E., Salvadó M., Trampuz A., Siverio A., Alier A., Sorli L. et al. Improved diagnosis of orthopedic implant-associated infection by inoculation of sonication fluid into blood culture bottles. J Clin Microbiol. 2015;53(5):1622-1627. doi: 10.1128/JCM.03683-14.
  24. Tande A.J., Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27:302-345. doi: 10.1128/CMR.00111-13.
  25. Drago L., Signori V., De Vecchi E., Vassena C., Palazzi E., Cappelletti L. et al. Use of dithiothreitol to improve the diagnosis of prosthetic joint infections. J Orthop Res. 2013;31(11):1694-1699. doi: 10.1002/jor.22423.

Statistics

Views

Abstract: 697

Cited-by

CrossRef: 1

  1. Artyukh VA, Bozhkova SA, Boyarov AA, Muravyova JV, Kochish AA. Efficiency of the One-Stage Revision Hip Arthroplasty in Chronic Periprosthetic Joint Infection with Sinus Tract. Traumatology and Orthopedics of Russia. 2021;27(2):9. doi: 10.21823/2311-2905-2021-27-2-9-22

Dimensions

Article Metrics

Metrics Loading ...

PlumX


Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies