scholarly journals Plasma fibrinogen in the diagnosis of periprosthetic joint infection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Fei Yang ◽  
Chenyu Zhao ◽  
Rong Huang ◽  
Hui Ma ◽  
Xiaohe Wang ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Revision Arthroplasty ◽  
Cost Effective ◽  
Plasma Fibrinogen ◽  
Evidence Based ◽  
Joint Infections ◽  
Auc Value

AbstractPeriprosthetic joint infections (PJIs) have become the most catastrophic complication for patients after arthroplasty. Although previous studies have found that many biomarkers have good performance for diagnosing PJI, early diagnosis remains challenging and a gold standard is lacking. This study aimed to investigate the diagnostic accuracy of plasma fibrinogen (FIB) in detecting PJI compared to other traditional biomarks (CRP, WBC and ESR). A total of 156 patients (including 57 PJI and 99 non-PJI patients) who underwent revision arthroplasty were retrospectively reviewed from 01/2014 to 01/2020. The diagnostic criteria of PJI were mainly based on the definition from the evidence-based definition for periprosthetic joint infection in 2018. The optimal plasma FIB predictive cutoff was 4.20 g/L, the sensitivity of the plasma fibrinogen was 0.860, the specificity was 0.900, the positive predictive value (PPV) was 0.831, and the negative predictive value (NPV) was 0.908. The area under the curve (AUC) value of plasma fibrinogen was 0.916 (95% CI 0.869–0.964), and the CRP, ESR and WBC levels had AUCs of 0.901, 0.822 and 0.647, respectively. Plasma FIB demonstrated better diagnostic strength compared with that of other serum biomarkers before revision arthroplasty. It represents a new horizon for the diagnosis of PJI due to the diagnosis values and cost-effective features.

scholarly journals Diagnostic accuracy of multiplex polymerase chain reaction on tissue biopsies in periprosthetic joint infections

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Igor Lazic ◽  
Susanne Feihl ◽  
Peter M. Prodinger ◽  
Ingo J. Banke ◽  
Andrej Trampuz ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Multiplex Pcr ◽  
Predictive Value ◽  
Joint Infection ◽  
False Negative ◽  
Revision Arthroplasty ◽  
Pathogen Identification ◽  
Negative Results ◽  
Joint Infections ◽  
Pcr Assays

AbstractThe diagnosis and treatment of periprosthetic joint infection (PJI) currently relies on cultures, which are time-consuming and often fail. Multiplex PCR assays promise reliable and prompt results, but have been heterogeneously evaluated. In this study, we analyse multiplex PCR in pathogen identification using only tissue biopsies. 42 patients after revision arthroplasty of the hip or knee were evaluated using multiplex PCR to identify microorganisms. The patients were classified according to the diagnostic criteria published by Zimmerli et al. and the results were compared to the respective microbiological cultures. PJI was detected in 15 patients and 27 revisions were aseptic. The multiplex PCR of tissue biopsies had a sensitivity of 0.3 (95% CI 0.12–0.62), a specificity of 1.0 (0.87–1.0), a positive predictive value of 1.0 (0.48–1.0) and a negative predictive value of 0.73 (0.56–0.86). The diagnostic accuracy of multiplex PCR on tissue biopsy samples is low in comparison to routine microbiological cultures. The evaluation of tissue biopsies using multiplex PCR was prone to false negative results. However, multiplex PCR assays have the advantage of rapid pathogen identification. We therefore recommend further investigation of multiplex PCR in the setting of suspected PJI with a careful choice of specimens.

scholarly journals Acute or chronic periprosthetic joint infection? Using the ESR ∕ CRP ratio to aid in determining the acuity of periprosthetic joint infections

2021 ◽  
Vol 6 (6) ◽  
pp. 229-234
Author(s):  
Zachary K. Christopher ◽  
Kade S. McQuivey ◽  
David G. Deckey ◽  
Jack Haglin ◽  
Mark J. Spangehl ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Operating Characteristic ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Chronic Patients ◽  
Joint Infections ◽  
The Mean ◽  
Acute Patients ◽  
The Ideal

Abstract. Introduction: The gold standard for determining the duration of periprosthetic joint infection (PJI) is a thorough history. Currently, there are no well-defined objective criteria to determine the duration of PJI, and little evidence exists regarding the ratio between ESR (mm/h) and CRP (mg/L) in joint arthroplasty. This study suggests the ESR / CRP ratio will help differentiate acute from chronic PJI. Methods: Retrospective review of patients with PJI was performed. Inclusion criteria: patients >18 years old who underwent surgical revision for PJI and had documented ESR and CRP values. Subjects were divided into two groups: PJI for greater (chronic) or less than (acute) 4 weeks and the ESR / CRP ratio was compared between them. Receiver-operating characteristic (ROC) curves were evaluated to determine the utility of the ESR / CRP ratio in characterizing the duration of PJI. Results: 147 patients were included in the study (81 acute and 66 chronic). The mean ESR / CRP ratio in acute patients was 0.48 compared to 2.87 in chronic patients (p<0.001). The ESR / CRP ROC curve demonstrated an excellent area under the curve (AUC) of 0.899. The ideal cutoff value was 0.96 for ESR / CRP to predict a chronic (>0.96) vs. acute (<0.96) PJI. The sensitivity at this value was 0.74 (95 % CI 0.62–0.83) and the specificity was 0.90 (95 % CI 0.81–0.94). Conclusions: The ESR / CRP ratio may help determine the duration of PJI in uncertain cases. This metric may give arthroplasty surgeons more confidence in defining the duration of the PJI and therefore aid in treatment selection.

scholarly journals Late onset periprosthetic joint infection of the knee caused by Streptococcus anginosus. Case presentation and literature review

2021 ◽  
Vol 15 (03) ◽  
pp. 436-441
Author(s):  
Giuseppe Marongiu ◽  
Marco Conte ◽  
Vincenzo Verderosa ◽  
Stefano Congia ◽  
Giuseppe Dessì ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Late Onset ◽  
Joint Infection ◽  
Rare Event ◽  
Revision Arthroplasty ◽  
Orthopedic Implants ◽  
Streptococcus Anginosus ◽  
Joint Infections ◽  
Causative Agents ◽  
Periprosthetic Knee Infection

Periprosthetic joint infection (PJI) is one of the most dramatic complications of joint arthroplasty. Although streptococcal bone and joint infections are less common than staphylococcal cases, their role as causative agents of bone and joint remains significant accounting for at least 10% of PJIs. Streptococcus anginosus group (SAG) bacteria are usually found in the normal flora of the urogenital tract, intestinal tract and oropharynx and could cause pyogenic infections to affect brain, lungs and liver. SAG bacteria are uncommonly reported as a cause of osteomyelitis and the involvement of a joint represent a rare event. S. anginosus has been anecdotical related to implant devices infections such as vascular prosthesis or orthopedic implants, however, PJI of the knee has never been fully reported before. We describe the case of a late onset periprosthetic knee infection due to Streptococcus anginosus successfully treated by a two-stage revision arthroplasty and postoperative parenteral Vancomycin, (2 g per day) and Levofloxacin (750 mg per day) for 4 weeks and then oral Levofloxacin for a further 2 weeks.

scholarly journals Preoperative diagnostic for periprosthetic joint infection prior to total knee revision arthroplasty

2014 ◽  
Vol 6 (3) ◽  
Author(s):  
Leif Claassen ◽  
Kerstin Radtke ◽  
Max Ettinger ◽  
Christian Plaass ◽  
Gabriela Von Lewinski
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Inflammatory Markers ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Revision Operation ◽  
Total Knee ◽  
Serum Inflammatory Markers

Periprosthetic joint infection (PJI) after total knee arthroplasty remains a challenging problem. The aim of this study was to evaluate the accuracy of diagnostic knee aspiration and serum inflammatory markers in diagnostic of a PJI after total knee arthroplasty. Within 2011 and 2012, 46 patients received a one- or two-stage revision arthroplasty of the knee joint. These patients received a total number of 77 operations. A preoperative aspiration was performed in each case. We analyzed the microbiological and histological examinations of the samples from the aspiration and from the revision operation and additionally estimated serum inflammatory markers. The diagnostic aspiration had a specificity of 0.87, a sensitivity of 0.39, a positive predictive value of 0.67 and a negative predictive value of 0.68. For C-reactive protein the specificity was 0.61 and the sensitivity was 0.48, the serum white blood cell count had a specificity of 0.98 and a sensitivity of 0.23. Our data queries whether diagnostic joint aspiration or serum inflammatory markers are sufficient to verify or exclude a PJI.

scholarly journals Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee

2019 ◽  
Vol 10 (10) ◽  
pp. 348-355 ◽  
Author(s):  
Ewout S Veltman ◽  
Dirk Jan F Moojen ◽  
Marc L van Ogtrop ◽  
Rudolf W Poolman
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Two Stage

Outcomes of revision arthroplasty for shoulder periprosthetic joint infection: a three-stage revision protocol

2019 ◽  
Vol 28 (2) ◽  
pp. 268-275 ◽  
Author(s):  
Wo-Jan Tseng ◽  
Drew A. Lansdown ◽  
Trevor Grace ◽  
Alan L. Zhang ◽  
Brian T. Feeley ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty

Development of antibiotic resistance in periprosthetic joint infection after total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 171-176
Author(s):  
Antonio Klasan ◽  
Arne Schermuksnies ◽  
Florian Gerber ◽  
Matt Bowman ◽  
Susanne Fuchs-Winkelmann ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Resistance ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Bacterial Strains ◽  
Coagulase Negative Staphylococci ◽  
Primary Arthroplasty ◽  
Total Knee

Aims The management of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is challenging. The correct antibiotic management remains elusive due to differences in epidemiology and resistance between countries, and reports in the literature. Before the efficacy of surgical treatment is investigated, it is crucial to analyze the bacterial strains causing PJI, especially for patients in whom no organisms are grown. Methods A review of all revision TKAs which were undertaken between 2006 and 2018 in a tertiary referral centre was performed, including all those meeting the consensus criteria for PJI, in which organisms were identified. Using a cluster analysis, three chronological time periods were created. We then evaluated the antibiotic resistance of the identified bacteria between these three clusters and the effectiveness of our antibiotic regime. Results We identified 129 PJIs with 161 culture identified bacteria in 97 patients. Coagulase-negative staphylococci (CNS) were identified in 46.6% cultures, followed by Staphylococcus aureus in 19.8%. The overall resistance to antibiotics did not increase significantly during the study period (p = 0.454). However, CNS resistance to teicoplanin (p < 0.001), fosfomycin (p = 0.016), and tetracycline (p = 0.014) increased significantly. Vancomycin had an 84.4% overall sensitivity and 100% CNS sensitivity and was the most effective agent. Conclusion Although we were unable to show an overall increase in antibiotic resistance in organisms that cause PJI after TKA during the study period, this was not true for CNS. It is concerning that resistance of CNS to new antibiotics, but not vancomycin, has increased in a little more than a decade. Our findings suggest that referral centres should continuously monitor their bacteriological analyses, as these have significant implications for prophylactic treatment in both primary arthroplasty and revision arthroplasty for PJI. Cite this article: Bone Joint J 2021;103-B(6 Supple A):171–176.

Plasma Fibrinogen Exhibits Better Performance Than Plasma D-Dimer in the Diagnosis of Periprosthetic Joint Infection

2019 ◽  
Vol 101 (7) ◽  
pp. 613-619 ◽  
Author(s):  
Rui Li ◽  
Hong-Yi Shao ◽  
Li-Bo Hao ◽  
Bao-Zhan Yu ◽  
Peng-Fei Qu ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Plasma Fibrinogen ◽  
D Dimer

scholarly journals Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Bao-Zhan Yu ◽  
Jun Fu ◽  
Wei Chai ◽  
Li-Bo Hao ◽  
Ji-Ying Chen
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Early Postoperative Period ◽  
Infected Group ◽  
Neutrophil To Lymphocyte Ratio ◽  
Musculoskeletal Infection ◽  
Lymphocyte Ratio ◽  
Total Knee

Abstract Background Periprosthetic joint infection (PJI) is a catastrophic complication after total knee or hip arthroplasty. The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for diagnosing infectious diseases. The objective of this study was to investigate the accuracy of the NLR for the diagnosis of early PJI after total knee or hip arthroplasty. Methods We retrospectively evaluated consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018.There were 20 cases diagnosed early PJI and 101 uninfected cases on the basis of the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood-cell (WBC) count, NLR and interleukin-6 (IL-6) were compared between the two groups. Receiver operating characteristic curves were generated to estimate the optimal cutoff values for each parameter. The sensitivity, specificity, positive predictive value and negative predictive value for each parameter were calculated. Results The CRP, ESR, WBC, NLR and IL-6 values were all significally higher in the infected group than the uninfected group. The median of CRP was 66.6 mg/l in the infected group and 8.6 mg/l in the uninfected group (p < 0.001). The median of ESR was 34.8 mm/hr. in the infected group and 17.4 mm/hr. in the uninfected group (p < 0.001). In the infected group and uninfected group, the median of WBC was 8.2X109 /L and 6.1 X109 /L (p = 0.002), respectively; while the median of NLR was 5.2 and 2.1 (p < 0.001). The median of IL-6 was 46 pg/ml and 6.4 pg/ml (p < 0.001),respectively. The best parameter for the diagnosis of early PJI was IL-6 (AUC = 0.814) followed by the NLR (AUC =0.802), CRP (AUC =0.793), ESR (AUC =0.744) and WBC (AUC = 0.632). Conclusions This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is a cheap and convenient parameter to be calculated in daily practice without extra costs.

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