scholarly journals AB0940 BIOMARKERS IN THE DIAGNOSIS OF ACUTE HOT JOINTS: AN EVALUATION OF RESEARCH INTEREST 1960-2018

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1769.2-1769
Author(s):  
M. Dey ◽  
M. Al-Attar ◽  
L. Peruffo ◽  
I. Wilson ◽  
S. S. Zhao ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
United Kingdom ◽  
Synovial Fluid ◽  
Septic Arthritis ◽  
Joint Infection ◽  
Research Interest ◽  
Diagnostic Biomarkers ◽  
Prosthetic Joints ◽  
Prosthetic Joint ◽  
Crystal Arthritis

Background:The acute hot joint presentation is a common clinical emergency, often the result of crystal arthritis or trauma. However, all diagnoses can mimic septic arthritis, which should be excluded promptly due to the potential for rapid joint destruction and significant morbidity. The gold-standard test for septic arthritis is synovial fluid culture, which can take several days to perform. Meanwhile, patients are often admitted and given antimicrobials. Other specialties have made use of rapid biomarkers to exclude infection, for example, exclusion of empyema using pleural fluid pH and glucose [1]. Such biomarkers could reduce the need for lengthy hospital admissions and inappropriate antibiotic use in the acute hot joint presentation.Objectives:1.Evaluate research interest over time, on the use of diagnostic biomarkers in the acute hot joint presentation.2.Compare research interest in the use of diagnostic biomarkers in acute hot native versus acute hot prosthetic joints.Methods:We performed a review of the number of publications reporting the use and diagnostic accuracy of biomarkers to exclude infection in the acute hot joint presentations. The database,Scopus, was searched for English-language studies (1946-2018) using search terms relating to septic arthritis, crystal arthritis, and diagnostic markers derived from synovial fluid/aspirate. The number of papers published per year on prosthetic joints only was also calculated. Therefore, the following were recorded for each year 1946-2018: total number of studies; prosthetic joints only; native joints only. Values were plotted, with polynomial trend-lines and R2calculated.Results:Our search yielded 2279 relevant studies in total (561 on prosthetic joints), published 1946-2018. Only 1 study was identified for the year 1946; the next recorded publication was in 1960. Therefore, this single study was excluded as an outlier. Results are presented in Figure 1. The number of studies on diagnostic biomarkers for acute hot joints continued to increase after 1960. From 2016, the number of studies conducted in prosthetic joints outnumbered those done in native joints. Polynomial trend-lines applied to the results showed studies on native acute hot joints are predicted to decline, while those in prosthetic joints will continue to increase.Conclusion:Reasons for an increasing number of studies on prosthetic compared to native acute hot joints include a narrower differential diagnosis in prosthetic joints, i.e. septic vs aseptic. In contrast, native acute hot joints may be the result of various causes including crystal arthritis, inflammatory arthritis, and trauma. Having a narrower differential diagnosis may facilitate diagnostic research in prosthetic joint presentations. Furthermore, incidence of prosthetic joint infection is also greater than that of native joint infection [2]. Nonetheless, the incidence of native joint infection is increasing [3]. This, and the lack of methods by which to rapidly distinguish native joint septic arthritis from non-infective causes, indicates that more research is required in this area.References:[1]Heffner JE et al. Pleural fluid chemical analysis in parapneumonic effusions. A meta-analysis. Am J Respir Crit Care Med. 1995 Jun;151(6):1700–8.[2]Roerdink RL et al. The difference between native septic arthritis and prosthetic joint infections: A review of literature. J Orthop Surg (Hong Kong).[3]Rutherford AI et al. A population study of the reported incidence of native joint septic arthritis in the United Kingdom between 1998 and 2013. Rheumatol (United Kingdom). 2016;55(12):2176–80.Disclosure of Interests:None declared

scholarly journals Synovial fluid presepsin as a novel biomarker for the rapid differential diagnosis of native joint septic arthritis from crystal arthritis

2021 ◽  
Vol 102 ◽  
pp. 472-477
Author(s):  
Takashi Imagama ◽  
Kazushige Seki ◽  
Toshihiro Seki ◽  
Atsunori Tokushige ◽  
Yuta Matsuki ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Synovial Fluid ◽  
Septic Arthritis ◽  
Crystal Arthritis

scholarly journals Bone and Joint Infections among Hematopoietic Stem Cell Transplant Recipients

2019 ◽  
Vol 4 (5) ◽  
pp. 209-215
Author(s):  
Cybele Lara Abad ◽  
Vania Phuoc ◽  
Prashant Kapoor ◽  
Pritish K. Tosh ◽  
Irene G. Sia ◽  
...  
Keyword(s):  
Stem Cell ◽  
Septic Arthritis ◽  
Hematopoietic Stem Cell ◽  
Joint Infection ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Prosthetic Joint ◽  
Increased Risk

Abstract. Background: Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk for infection. This study describes bone and joint infections (BJI) among HSCT recipients.Methods: We reviewed 5861 patients who underwent HSCT at Mayo Clinic, Rochester, MN from January 1, 2005 through January 1, 2015 for study inclusion. BJI was defined as native septic arthritis, prosthetic joint infection, osteomyelitis, and orthopedic implant infection. All adults with BJI after HSCT were included in the analysis.Results: Of 5861 patients, 33 (0.6%) developed BJI. Native joint septic arthritis was the most common BJI occurring in 15/33 (45.4%) patients. Patients were predominantly male (24/33, 72.7%), with median age of 58 (range 20-72) years. BJI was diagnosed a median of 39 (range 1-114) months after allogeneic (14/33, 42.4%) or autologous (19/33, 57.6%) HSCT. Organisms were recovered via tissue (24/27, 88.9%), synovial fluid (13/17, 76.5%), and/or blood cultures (16/25, 64%). Most underwent surgical debridement (23/33, 69.7%). Patients were followed a median of 78.3 months (range 74-119). Therapy was unsuccessful in 4/33 (12.1%), with death related to the underlying BJI in two (50%). Failure occurred a median of 3.4 (0.1-48.5) months from diagnosis. At last follow up, 7/33 (21.2%) patients were alive. Median overall survival was 13 months (0.07-70.6).Conclusion: BJI among HSCT recipients is infrequent. The most common infection is native joint septic arthritis. Pathogens appear similar to patients without HSCT. Treatment involving surgical-medical modalities is successful, with most patients surviving >1 year after BJI.

scholarly journals BACTERIAL (SEPTIC) ARTHRITIS AND PROSTHETIC JOINT INFECTION

2017 ◽  
Vol 55 (2) ◽  
pp. 192-200 ◽  
Author(s):  
B. S. Belov ◽  
S. A. Makarov ◽  
E. I. Byalik
Keyword(s):  
Septic Arthritis ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Prosthetic Joint

Diagnostic accuracy of alpha-defensin enzyme-linked immunosorbent assay in the clinical evaluation of painful hip and knee arthroplasty with possible prosthetic joint infection

2019 ◽  
Vol 101-B (8) ◽  
pp. 970-977 ◽  
Author(s):  
S. Kleiss ◽  
N. M. Jandl ◽  
A. Novo de Oliveira ◽  
W. Rüther ◽  
A. Niemeier
Keyword(s):  
Synovial Fluid ◽  
Diagnostic Accuracy ◽  
Immunosorbent Assay ◽  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Coagulase Negative Staphylococci ◽  
Predictive Values ◽  
Prosthetic Joint

Aims The aim of this study was to evaluate the diagnostic accuracy of the synovial alpha-defensin enzyme-linked immunosorbent assay (ELISA) for the diagnosis of prosthetic joint infection (PJI) in the work-up prior to revision of total hip (THA) and knee arthroplasty (TKA). Patients and Methods Inclusion criteria for this prospective cohort study were acute or chronic symptoms of the index joint without specific exclusion criteria. Synovial fluid aspirates of 202 patients were analyzed and semiquantitative laboratory alpha-defensin ELISA was performed. Final diagnosis of PJI was established by examination of samples obtained during revision surgery. Results Sensitivity and specificity of the alpha-defensin ELISA for PJI were 78.2% (95% confidence interval (CI) 66.7 to 88.5) and 96.6% (95% CI 93.0 to 99.3). Positive and negative predictive values were 89.6% (95% CI 80.6 to 97.8) and 92.2% (95% CI 87.5 to 96.1). The test remained false-negative in 22% of septic revisions, most of which were due to coagulase-negative staphylococci all occurring in either late-chronic or early-postoperative PJI. Conclusion The routine use of synovial fluid alpha-defensin laboratory ELISA in the preoperative evaluation of symptomatic THAs and TKAs is insufficient to accurately diagnose PJI. Particularly in cases involving low-virulence organisms, such as coagulase-negative staphylococci, there remains a need for tests with a higher sensitivity. Cite this article: Bone Joint J 2019;101-B:970–977.

scholarly journals Role of Phenol-Soluble Modulins in Formation of Staphylococcus aureus Biofilms in Synovial Fluid

2015 ◽  
Vol 83 (7) ◽  
pp. 2966-2975 ◽  
Author(s):  
Sana S. Dastgheyb ◽  
Amer E. Villaruz ◽  
Katherine Y. Le ◽  
Vee Y. Tan ◽  
Anthony C. Duong ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Synovial Fluid ◽  
Antibiotic Treatment ◽  
Joint Infection ◽  
Regulatory System ◽  
Surface Proteins ◽  
Host Matrix ◽  
Content Type ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Staphylococcus aureusis a leading cause of prosthetic joint infections, which, as we recently showed, proceed with the involvement of biofilm-like clusters that cause recalcitrance to antibiotic treatment. Here we analyzed why these clusters grow extraordinarily large, reaching macroscopically visible extensions (>1 mm). We found that while specificS. aureussurface proteins are a prerequisite for agglomeration in synovial fluid, low activity of the Agr regulatory system and subsequent low production of the phenol-soluble modulin (PSM) surfactant peptides cause agglomerates to grow to exceptional dimensions. Our results indicate that PSMs function by disrupting interactions of biofilm matrix molecules, such as the polysaccharide intercellular adhesin (PIA), with the bacterial cell surface. Together, our findings support a two-step model of staphylococcal prosthetic joint infection: As we previously reported, interaction ofS. aureussurface proteins with host matrix proteins such as fibrin initiates agglomeration; our present results show that, thereafter, the bacterial agglomerates grow to extremely large sizes owing to the lack of PSM expression under the specific conditions present in joints. Our findings provide a mechanistic explanation for the reported extreme resistance of joint infection to antibiotic treatment, lend support to the notions that Agr functionality and PSM production play a major role in defining different forms ofS. aureusinfection, and have important implications for antistaphylococcal therapeutic strategies.

scholarly journals Bacterial (septic) arthritis and prosthetic joint infection

2016 ◽  
Vol 18 (12) ◽  
pp. 110-116 ◽  
Author(s):  
B.S. Belov ◽  
◽  
S.A. Makarov ◽  
E.I. Bialik ◽  
◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Prosthetic Joint

scholarly journals Evaluation of a rapid lateral flow calprotectin test for the diagnosis of prosthetic joint infection

2019 ◽  
Author(s):  
Alexander J. Trotter ◽  
Rachael Dean ◽  
Celia E. Whitehouse ◽  
Jarle Mikalsen ◽  
Claire Hill ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Sensitivity And Specificity ◽  
Prosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Lateral Flow ◽  
Lateral Flow Assay ◽  
Prosthetic Joint ◽  
Flow Test ◽  
Lateral Flow Test

AbstractBackgroundMicrobiological diagnosis of prosthetic joint infection (PJI) relies on culture techniques that are slow and insensitive. Rapid tests are urgently required to improve patient management. Calprotectin is a neutrophil biomarker of inflammation that has been demonstrated to be effective for the diagnosis of PJI. A calprotectin based lateral flow test has been developed for the rapid detection of PJI using synovial fluid samples.MethodsA convenience series of 69 synovial fluid samples from patients at the Norfolk and Norwich University Hospitals (NNUH) were collected intraoperatively from 52 hip and 17 knee revision operations. Calprotectin levels were measured using a new commercially available lateral flow assay for PJI diagnosis (Lyfstone). For all samples, synovial fluid was pipetted onto the lateral flow device and the signal was read using a mobile phone app after 15 minutes incubation at room temperature.ResultsAccording to the Musculoskeletal Infection Society (MSIS) criteria, 24 patients were defined as PJI positive and the remaining 45 were negative. The overall accuracy of the lateral flow test against the MSIS criteria was 75%. The test had a sensitivity and specificity of 75% and 76% respectively with a positive predictive value (PPV) of 62% and a negative predictive value (NPV) of 85%. Discordant results were then reviewed by the clinical team using available patient data to develop an alternative gold standard for defining presence/absence of infection (MSIS+). Compared to MSIS+, the test showed an overall accuracy of 83%, sensitivity and specificity of 95% and 78% respectively, a PPV of 62% and an NPV of 98%. Test accuracy for hip revisions was 77% and for knee revisions was 100%.ConclusionsThis study demonstrates that the calprotectin lateral flow assay is an effective diagnostic test for PJI. Our data suggests that the test is likely to generate false positive results in patients with metallosis and gross osteolysis.

scholarly journals Micromonas micros Infection of a Prosthetic Hip Joint: A Case Report and Review of the Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Abhimanyu Aggarwal ◽  
Durane Walker
Keyword(s):  
Antibiotic Prophylaxis ◽  
Hip Joint ◽  
Joint Infection ◽  
Dental Procedure ◽  
Joint Infections ◽  
Prosthetic Joints ◽  
Prosthetic Joint ◽  
Dental Procedures ◽  
Prosthetic Joint Infections ◽  
Hematogenous Seeding

Micromonas micros is an oral anaerobic Gram-positive coccus and is a commensal of the mouth, and it is rarely isolated in prosthetic joint infections (PJIs) and even less frequently related to a preceding dental procedure with eventual hematogenous seeding of the prosthetic joint. Here, we present a case of a 56-year-old male with a prosthetic hip joint who developed Micromonas micros prosthetic hip joint infection with symptoms starting a few days after a dental procedure and not having received periprocedural antibiotic prophylaxis. He recovered well with surgical intervention and antimicrobial therapy. We conducted a literature review of prosthetic hip joint infections caused by Micromonas micros as well as briefly discuss current guidelines on antibiotic prophylaxis in patients with prosthetic joints undergoing dental procedures and some knowledge gaps.

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