SYNOVIAL FLUID D-LACTATE — BACTERIAL-SPECIFIC MARKER FOR INFECTION OF NATIVE AND PROSTHETIC JOINTS

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Abstract

Infection  of native  and prosthetic joints  remains  a critical  disease, associated  with  both  significant  mortality and morbidity. The diagnosis of joints infection is extremely  difficult since presentation and preoperative tests are not always obvious and precise, while correct  and timely diagnosis of septic etiology is crucial. In this case a rapid and accurate  test would be helpful.

Purpose of the study — тo evaluate  the analytical performance  and diagnostic  capabilities  of measuring  the synovial fluid D-lactate for early diagnosis of infection in native and prosthetic joints.

Material and methods. Test group of patients (n = 86) contained two subgroups – patients with periprosthetic infection (PPI) (n = 58) and patients with bacterial arthritis (BA) (n = 28). Control group (n = 104) also included two subgroups – patients with aseptic instability of implant components (n = 75) and patients with osteoarthritis (OA) (n = 29).

Results. The authors  observed  that  SF D-lactate ≥1,2 mmol/l was the optimal  cutoff value for identifying patients with bacterial  causes. The higher SF levels of D-lactate were observed in patients with BA compared  to aseptic causes, (p<0,0001), as well as in patients with PJI in contrast to aseptic loosening of prosthesis (p<0,0001). In patients with native joints,  SF D-lactate had better sensitivity (92,8%)  compared  to SF leucocytes  (66,6%)  and percentage of neutrophils (44,4%).  D-lactate had  better sensitivity for diagnosis  of PJI  (96,5%, 89,6% and  60,3% respectively). There  were no significant differences in SF D-lactate levels due to different bacterial  strains.

Conclusion. The study demonstrated high analytical performance and diagnostic  capabilities  of measuring of synovial fluid D-lactate for diagnosis of BA and PJI. It is a rapid and accurate  test for differentiating bacterial  joint infection from the aseptic  inflammatory joint diseases. This procedure can be carried  out within  less than  one hour and be helpful in outpatient setting.

About the authors

S. B. Karbysheva

Federal Center of Traumatology, Orthopedics and Arthroplasty

Author for correspondence.
Email: Ksb28@mail.ru

Svetlana   B.  Karbysheva   –  Clinical   Microbiologist  of the Clinical  Diagnostic Laboratory.

1/3, ul. Lyapidevskogo, Barnaul, 656045

Russian Federation

L. G. Grigoricheva

Federal Center of Traumatology, Orthopedics and Arthroplasty

Email: fake@neicon.ru

Ludmila  G.  Grigoricheva  – Cand.  Sci.  (Med.),   Medical Director.

1/3, ul. Lyapidevskogo, Barnaul, 656045

Russian Federation

I. V. Zhyltsov

Vitebsk State Medical University

Email: fake@neicon.ru

Ivan V. Zhyltsov – Dr. Sci. (Med.),  Professor.

27, pr-t Frunze, Vitebsk, 210023

Belarus

V. M. Semenov

Vitebsk State Medical University

Email: fake@neicon.ru

Valery  M.  Semenov  – Dr.  Sci.  (Med.),   Professor,  Head of the Infectious Diseases Department.

27, pr-t Frunze, Vitebsk, 210023

Belarus

A. G. Zolovkina

Federal Center of Traumatology, Orthopedics and Arthroplasty

Email: fake@neicon.ru

Anna G. Zolovkina – Cand. Sci. (Med.), Head of the Clinical Diagnostic Laboratory.

1/3, ul. Lyapidevskogo, Barnaul, 656045

Russian Federation

I. S. Veremei

Vitebsk State Medical University

Email: fake@neicon.ru

Igor  S.  Veremei  – Senior  Researcher  of  the  Infectious Diseases Department.

27, pr-t Frunze, Vitebsk, 210023

Belarus

А. Trampuz

Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin

Email: fake@neicon.ru

Andrej Trampuz – Dr. Sci. (Med.),  Head of the Center, Research  group Leader  of the  Biofilm Research  Laboratory.

1, Augustenburger Platz, Berlin, 13353

Germany

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