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

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.

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The Performance of a Dithiothreitol-Based Diagnostic System in Diagnosing Periprosthetic Joint Infection Compared to Sonication Fluid Cultures and Tissue Biopsies

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1150-8396 ◽

2020 ◽

Author(s):

Thomas Martin Randau ◽

Ernst Molitor ◽

Frank Sebastian Fröschen ◽

Achim Hörauf ◽

Hendrik Kohlhof ◽

...

Keyword(s):

Joint Infection ◽

False Negative ◽

Revision Arthroplasty ◽

Diagnostic System ◽

Low Ph ◽

Joint Fluid ◽

Histopathological Analysis ◽

Care Hospital ◽

Negative Results ◽

False Negative Results

Abstract Purpose The aim of this study was to evaluate the performance of a commercially available dithiothreitol (DTT) kit for routine use in diagnosing periprosthetic joint infections (PJIs) in comparison to conventional microbiological tissue specimens and sonication procedures in a maximal care hospital. Methods We applied the DTT system in 40 consecutive cases of revision arthroplasty (23 PJIs and 17 aseptic revisions), with an exchange or a removal of components. The hardware components were split between the DTT system and the conventional sonication procedure. At least three tissue biopsies and a joint fluid specimen were sent for microbiological and histopathological analysis. Data was analysed retrospectively to compare between the different methods. Results Cultures of the DTT fluid showed a sensitivity of 65% and specificity of 100%, as referenced to conventional microbiological cultures. Sonication had better sensitivity (75%) but lower specificity (85%). The categorical agreement of DTT cultures compared to sonication fluid cultures was 78% (31/40). Neither pathogen type, infection duration nor antibiotic pretreatment influenced the accuracy of the DTT, but a low pH in the DTT seemed to be associated with false-negative results. Conclusion DTT was inferior in sensitivity when diagnosing PJIs compared to sonication fluid cultures and tissue biopsies. A low pH in the DTT fluid correlated with false-negative results. Nevertheless, the closed system of the DTT kit avoids contamination and false-positive results, and DTT can be an alternative where sonication is not available.

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RhD-induced immunogenetic disparity between mother and fetus: medical and economic effect of using molecular genetic technology

Obstetrics Gynecology and Reproduction ◽

10.17749/2313-7347/ob.gyn.rep.2021.245 ◽

2020 ◽

Author(s):

A. G. Konopliannikov ◽

A. N. Toropovskii ◽

D. A. Viktorov ◽

Yu. V. Myakisheva ◽

R. F. Burganova ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Pregnant Women ◽

Economic Efficiency ◽

Predictive Value ◽

False Negative ◽

Test System ◽

Negative Results ◽

Diagnostic Characteristics ◽

D Antigen ◽

The Cost

Introduction. The article discusses the problem of timely diagnosis and prevention of Rh-immunity of pregnant women and hemolytic disease of the fetus, which remains relevant today, despite the existence of proven methods of diagnosis, treatment and prevention.Aim: to assess the medico-economic efficiency of non-invasive prenatal diagnostics of the Rh factor (rhesus D antigen, RhD) of the fetus in the mother's blood – RhD-genotyping of the fetus.Materials and Methods. In a retrospective observational study, the results were analyzed of determining the Rh-factor of the fetus in the blood of 4109 Rh-negative pregnant women observed in 41 medical organizations of the Ulyanovsk region in the period 2018–2020. At a gestational age of ≥ 10 weeks, the RhD state of the fetus was determined by polymerase chain reaction. To assess the medical effectiveness of the test, the sensitivity, specificity, predictive value of positive and negative results, and diagnostic accuracy were determined. The data collected during the study were compared with the information obtained after childbirth. To assess the economic efficiency, the difference between the cost of immunization and the cost of determining the D antigen of the Rhesus system (Rh factor) of the fetus was determined.Results. A positive Rh-factor of the fetus was detected in 67.26 % of cases (n = 2793), negative – in 32.74 % (n = 1316). Diagnostic accuracy of the test system "Test-RhD" was 99.40 %, the sensitivity – 99.84 %, the specificity – 97.51 %, the prognostic value of a positive result – 99.43 %, the predictive value of a negative result – 99.28 % with low rates of false positive and false negative results. It has been shown that this study avoids unnecessary immunization costs for all Rh-negative pregnant women.Conclusion. Analysis of the diagnostic characteristics and cost-effectiveness of the RhD test indicate the high medical significance of the method and make it possible to recommend its wider use.

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Plasma fibrinogen in the diagnosis of periprosthetic joint infection

Scientific Reports ◽

10.1038/s41598-020-80547-z ◽

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.

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The role of serum periostin in the diagnosis of asthma: A meta-analysis

Allergy and Asthma Proceedings ◽

10.2500/aap.2020.41.200038 ◽

2020 ◽

Vol 41 (4) ◽

pp. 240-247

Author(s):

Lei Yang ◽

Qingtao Zhao ◽

Shuyu Wang

Keyword(s):

Diagnostic Accuracy ◽

Meta Analysis ◽

Characteristic Curve ◽

False Negative ◽

Summary Receiver Operating Characteristic ◽

True Negative ◽

Negative Results ◽

Noninvasive Biomarker ◽

Sensitivity Specificity ◽

Serum Periostin

Background: Serum periostin has been proposed as a noninvasive biomarker for asthma diagnosis and management. However, its accuracy for the diagnosis of asthma in different populations is not completely clear. Methods: This meta-analysis aimed to evaluate the diagnostic accuracy of periostin level in the clinical determination of asthma. Several medical literature data bases were searched for relevant studies through December 1, 2019. The numbers of patients with true-positive, false-positive, false-negative, and true-negative results for the periostin level were extracted from each individual study. We assessed the risk of bias by using Quality Assessment of Diagnostic Accuracy Studies 2. We used the meta-analysis to produce summary estimates of accuracy. Results: In total, nine studies with 1757 subjects met the inclusion criteria. The pooled estimates of sensitivity, specificity, and diagnostic odds ratios for the detection of asthma were 0.58 (95% confidence interval [CI], 0.38‐0.76), 0.86 (95% CI, 0.74‐0.93), and 8.28 (95% CI, 3.67‐18.68), respectively. The area under the summary receiver operating characteristic curve was 0.82 (95% CI, 0.79‐0.85). And significant publication bias was found in this meta‐analysis (p = 0.39). Conclusion: Serum periostin may be used for the diagnosis of asthma, with moderate diagnostic accuracy.

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Evaluation of the Carba NP Test for Rapid Detection of Carbapenemase-Producing Enterobacteriaceae and Pseudomonas aeruginosa

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00878-13 ◽

2013 ◽

Vol 57 (9) ◽

pp. 4578-4580 ◽

Cited By ~ 147

Author(s):

Nathalie Tijet ◽

David Boyd ◽

Samir N. Patel ◽

Michael R. Mulvey ◽

Roberto G. Melano

Keyword(s):

Pseudomonas Aeruginosa ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Rapid Detection ◽

False Negative ◽

Bacterial Extract ◽

Content Type ◽

Negative Results ◽

False Negative Results

ABSTRACTThe Carba NP test was evaluated against a panel of 244 carbapenemase- and non-carbapenemase-producingEnterobacteriaceaeandPseudomonas aeruginosaisolates. We confirmed the 100% specificity and positive predictive value of the test, but the sensitivity and negative predictive value were 72.5% and 69.2%, respectively, and increased to 80% and 77.3%, respectively, using a more concentrated bacterial extract. False-negative results were associated with mucoid strains or linked to enzymes with low carbapenemase activity, particularly OXA-48-like, which has emerged globally in enterobacteria.

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Diagnostic accuracy of QuickVue® Dipstick Strep A test and its effect on antibiotic prescribing in children in the United Arab Emirates

BMC Pediatrics ◽

10.1186/s12887-019-1761-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Seyed Ali Safizadeh Shabestari ◽

Zainab A. Malik ◽

Fadil Y. A. Al-Najjar

Keyword(s):

Diagnostic Accuracy ◽

United Arab Emirates ◽

Predictive Value ◽

Resistant Bacteria ◽

Antibiotic Prescribing ◽

Upper Respiratory Tract ◽

Sample Collection ◽

Throat Culture ◽

Negative Results ◽

Tract Infections

Abstract Background Unnecessary antibiotic prescription to patients with upper respiratory tract infections (URTIs) has led to the increase in antibiotics resistant bacteria rates. In this study, we evaluated the diagnostic accuracy of QuickVue® Dipstick Strep A test (QV-SAT) in children presenting with acute pharyngotonsillitis and its effect on antibiotic prescribing. Methods A single-gated diagnostic accuracy study of children with fever, runny nose, and tonsillitis presenting to a paediatric clinic between March 2016 and September 2018. Paired throat swabs for QV-SAT and culture were collected. None of the children received antibiotics prior to sample collection. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the test were calculated. Results Two hundred four children were included in this study. 111 (54.4%) were boys and 146 (71.6%) were under the age of 5 years. QV-SAT was positive in 44 (21.6%) and throat culture was positive for Group A β- haemolytic Streptococcus (GAS) in 42 (20.6%) of the children. The results of QV-SAT were highly consistent with culture results: only 2 (0.9%) children with negative results had a positive throat culture. The sensitivity of the QV-SAT in the identification of GAS infection was 100% (95% CI 91.6%, 100%) and the NPV was 100% (95% CI 99.9%, 100%). Only 42 children ( 20.6%) were given antibiotics, while 162 (79.4%) were not. Conclusion The QV-SAT is a quick and reliable test that can help dramatically reduce antibiotic prescriptions to children presenting with fever and acute pharyngotonsillitis.

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Transhepatic forceps biopsy after PTCD for histological assessment of bile duct stenoses or occlusions

Zeitschrift für Gastroenterologie ◽

10.1055/a-0821-7060 ◽

2019 ◽

Vol 57 (02) ◽

pp. 133-138

Author(s):

Eva-Marie Warnken ◽

Michael Uder ◽

Hubert Stein ◽

Michael Wucherer ◽

Michael Lell ◽

...

Keyword(s):

Predictive Value ◽

False Negative ◽

Short Term ◽

Microsoft Excel ◽

Ct Guided ◽

Forceps Biopsy ◽

Negative Results ◽

False Negative Results ◽

Pet Ct ◽

Ct Guided Biopsy

Abstract Purpose The goal of this study was to evaluate the experience of 11 years of wire-guided forceps biopsy via PTCD in patients with obstructive jaundice. Materials and methods In a retrospective approach, 56 biopsies in 51 patients were analyzed (22 female, 29 male). Data was collected from 2006 to 2016. Mean age was 71 years (range: 34 – 86 years). Data was extracted from dig. Patients’ records (KIS, PACS, RIS) to be analyzed in Microsoft Excel. Results All 56 procedures were technically successful. Stenosis in anastomoses were benign due to scarring in 7 patients and in 9 due to papillitis or others. In 4 patients, results in anastomosis were malignant. In 19 patients without anastomosis, CCC was the diagnosis, thereof 10 klatskin, 9 stenosis in other locations, followed by gastric, pancreatic, and colon carcinoma in 5, 3, and 2 patients. Three patients had a CUP (multimetering in case of more than 1 related category). Overall results were 35 mal. and 16 benign, 76.8 % of all proc. had a correct histopathologic result, and 23.2 % were false negative. Sensitivity was 65.8 %, which results in negative predictive value of 58.1 %. There was no false positive and so specificity was 100 %, as was the positive predictive value. False negative results (no malignancy but clinically and imaging suspect) were corrected by rerunning the procedure, by CT-guided biopsy or by 1 PET-CT. In 1 case the surg. sample brought the result. Minor complications occurred in 8 patients: shivering in 1 case, distinct but hemodynamically not relevant hemobilia in 5 cases, 2 portovenal bleedings. All bleedings were short-term and self-limiting. Conclusion Despite good feasibility, low peri- and post-interv. risk and high validity the forceps biopsy via PTCD is not widely used. For experienced interventionalists, it is an effective method for obtaining histology.

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The progestogen challenge test in postmenopausal women: clinical and morphologic aspects

Sao Paulo Medical Journal ◽

10.1590/s1516-31801996000300005 ◽

1996 ◽

Vol 114 (3) ◽

pp. 1166-1172

Author(s):

Claudia de Carvalho Ramos Bortoletto ◽

Edmund Chada Baracat ◽

Wagner José Gonçalves ◽

João Norberto Stávalle ◽

Geraldo Rodrigues de Lima ◽

...

Keyword(s):

Postmenopausal Women ◽

Predictive Value ◽

Fasting Blood Glucose ◽

False Negative ◽

Challenge Test ◽

Endometrial Biopsy ◽

Clinical Aspects ◽

Age At Menarche ◽

Histopathological Analysis ◽

Negative Results

The clinical aspects and anatomopathological patterns of 150 postmenopausal women were studied using the progestogen challenge test. An endometrial biopsy was obtained and submitted to the progestogen test. A histopathological analysis of the uterine mucosa from women with a positive progestogen test revealed that the endometrium was active in 44 percent of cases and atrophic or inactive in 56 percent. In contrast, among women with a negative response, the endometrium was atrophic in 94 percent of cases and active in 6 percent. Analysis of clinical aspects did not show significant differences between groups in terms of age; age at menarche and at menopause; fasting blood glucose levels; or body mass. However, postmenopausal time was significantly shorter for women with a positive test, with a correlation between postmenopausal time of one to two years and test positivity. The progestogen challenge test for the detection of atrophic endometrium presented 78.57 percent sensitivity, 77.05 percent specificity, 44 percent positive predictive value, and 94 percent negative predictive value. Thus, when negative, the test is highly valuable, indicating the presence of atrophic endometrium in 94 percent of cases. False-negative results occurred in only 6 percent of the subjects, with no case of hyperplasia detected. However, when the response to the test was positive, the endometrium was atrophic in 56 percent of the cases. We suggest that, in order to avoid invasive procedures, the progestogen challenge test be combined with other methods such as transvaginal ultrasonography.

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Noninvasive Electromagnetic Detection of Bladder Cancer

ISRN Urology ◽

10.1155/2014/802328 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Luigi Cormio ◽

Clarbruno Vedruccio ◽

Giorgio Leucci ◽

Paolo Massenio ◽

Giuseppe Di Fino ◽

...

Keyword(s):

Bladder Cancer ◽

Diagnostic Accuracy ◽

Predictive Value ◽

False Negative ◽

Electromagnetic Properties ◽

Urinary Cytology ◽

Predictive Values ◽

Electromagnetic Detection ◽

Voiding Symptoms ◽

Asymptomatic Patients

Objectives. Normal and neoplastic human tissues have different electromagnetic properties. This study aimed to determine the diagnostic accuracy of noninvasive electromagnetic detection of bladder cancer (BC) by the tissue-resonance interaction method (TRIM-prob). Patients and Methods. Consecutive patients were referred for cystoscopy because of (i) microscopic or gross hematuria and/or irritative voiding symptoms and (ii) bladder ultrasounds and urinary cytology findings negative or just suspicious of malignancy. Patients were first submitted to TRIM-prob bladder scanning by a single investigator and then to cystoscopy by another investigator blind to TRIM-prob data. Results. In 125 evaluated patients cystoscopy was positive for BC in 47 and negative in the remaining 78; conversely, TRIM-prob bladder scanning was positive for BC in 53 and negative in 72. In particular, TRIM-prob scanning yielded 7 false positives and only one false negative; therefore, its overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 97.9%, 89.9%, 86.8%, 98.6%, and 93.6%, respectively. Conclusions. TRIM-prob bladder scanning was a simple and quite accurate method for non-invasive electromagnetic detection of BC. If the elevated positive and negative predictive values will be replicated in further well-designed studies, it could be used to screen asymptomatic patients at high risk of BC.

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A New Modified MR Dual Precision Positioning of Thin-Slice Oblique Sagittal Fat Suppression Proton Density Weighted Imaging: Its Diagnostic Accuracy in Anterior Cruciate Ligament Injury and its Grades

10.21203/rs.3.rs-1119448/v1 ◽

2021 ◽

Author(s):

Kun Li ◽

Felix Young Jhonatan ◽

Zhaohui Yu ◽

Jinhua Chen ◽

Lixin Huang ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Cruciate Ligament ◽

False Negative ◽

Acl Injury ◽

Fat Suppression ◽

Ligament Injury ◽

Proton Density ◽

Precision Positioning ◽

Thin Slice

Abstract Purpose To evaluate the diagnostic accuracy of a new modified MR dual precision positioning of thin-slice oblique sagittal fat suppression proton density-weighted imaging (DPP-TSO-Sag-FS-PDWI) sequence in detecting ACL injuries and its grades compared to standard sequences using arthroscopy as the standard reference.Materials and Methods 42 patients enrolled in this retrospective study received the 1.5-T MRI with standard sequences and the new modified DPP-TSO-Sag-FS-PDWI sequence, and their arthroscopy results was recorded. The Mc Nemer-Bowker and weighted Kappa was performed to compare the consistency of MRI diagnosis with arthroscopic results. Finally, the diagnostic accuracy was calculated based on the true positive, true negative, false negative and false positive values.Results The diagnostic consistency of the DPP-TSO-Sag-FS-PDWI were higher than standard sequences for both reader 1 (K = 0.876 vs. 0.620) and reader 2 (K = 0.833 vs. 0.683) with good diagnostic repeatability (K = 0.794 vs. 0.598). Furthermore, the DPP-TSO-Sag-FS-PDWI can classify and diagnose three grades of ACL injury [the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value were more than 84%], especially for grade II injury as the PPV was superior for reader 1 (92.3% vs. 53.9%) and reader 2 (84.6% vs. 69.2%).Conclusion The new modified DPP-TSO-Sag-FS-PDWI sequence can display the ACL injury on one or continuous levels by maximizing the acquisition of complete ligament shape and true anatomical images, and excluding the influence of anatomical differences between individuals. It can improve the diagnostic accuracy with good repeatability and classify three grades of the ACL injury.

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