Neutrophil to Lymphocyte Ratio as a predictor for diagnosis of early Periprosthetic Joint Infection

Abstract Background: Periprosthetic joint infection (PJI) is a catastrophic complication after total joint arthroplasty (TJA). 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 the diagnosis of infection. The purpose of this study was to determine the accuracy of the NLR in the diagnosis of early PJI after total knee or hip joint arthroplasty.Methods: We retrospectively reviewed 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 based on the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters (C-reactive protein, erythrocyte sedimentation rate, white blood-cell count, NLR, interleukin-6 levels) were compared between the two groups. Receiver operating characteristic curves were generated to determine the optimal cutoff values for each parameter. Sensitivity, specificity, and positive and negative predictive values were calculated for each parameter. Results: The CRP, ESR, WBC, NLR and IL-6 values were all elevated in the infected group compared to the uninfected group. The mean CRP (infected=59.06, uninfected=10.09), ESR (infected=35, uninfected=17), WBC(infected=7.95x109,uninfected=6.16x109), NLR (infected=4.89, uninfected=2.18), IL-6 (infected=40.68, uninfected=7.46). All values were significant difference between the two groups. The best test for the diagnosis of early PJI was IL-6 (AUC=81.4%; optimal cutoff value 8.07pg/ml) followed by the NLR (AUC =80.2%; optimal cutoff value 2.13), CRP (AUC =79.3%; optimal cutoff value 9.27mg/l), ESR (AUC =74.4%; optimal cutoff value 22mm/h) and WBC (AUC = 63.2%; optimal cutoff value 8.91x109). 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 an easy, cheap and convenient parameters to be calculated in daily practice without extra costs.

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Neutrophil to Lymphocyte Ratio as a predictor for diagnosis of early Periprosthetic Joint Infection

10.21203/rs.3.rs-23878/v1 ◽

2020 ◽

Author(s):

BaoZhan Yu ◽

Jun Fu ◽

Wei Chai ◽

LiBo Hao ◽

Jiying Chen

Keyword(s):

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Predictive Value ◽

Joint Infection ◽

Neutrophil To Lymphocyte Ratio ◽

Optimal Cutoff ◽

Musculoskeletal Infection ◽

Cutoff Value ◽

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, 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 mean CRP (infected = 59.06, uninfected = 10.09), ESR (infected = 35, uninfected = 17), WBC(infected = 7.95 × 109,uninfected = 6.16 × 109), NLR (infected = 4.89, uninfected = 2.18), IL-6 (infected = 40.68, uninfected = 7.46).. The best parameter for the diagnosis of early PJI was IL-6 (AUC = 81.4%; optimal cutoff value 8.07 pg/ml) followed by the NLR (AUC = 80.2%; optimal cutoff value 2.13), CRP (AUC = 79.3%; optimal cutoff value 9.27 mg/l), ESR (AUC = 74.4%; optimal cutoff value 22 mm/h) and WBC (AUC = 63.2%; optimal cutoff value 8.91 × 109). 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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Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03704-5 ◽

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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Neutrophil to Lymphocyte Ratio as a predictor for diagnosis of early Periprosthetic Joint Infection

10.21203/rs.3.rs-23878/v4 ◽

2020 ◽

Author(s):

BaoZhan Yu ◽

Jun Fu ◽

Wei Chai ◽

LiBo Hao ◽

Jiying 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 8.6mg/l in the uninfected group (p<0.001). The median of ESR was 34.8 mm/hr in the infected group and 17.4mm/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 46pg/ml and 6.4pg/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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Neutrophil to Lymphocyte Ratio as a predictor for diagnosis of early Periprosthetic Joint Infection

10.21203/rs.3.rs-23878/v3 ◽

2020 ◽

Author(s):

BaoZhan Yu ◽

Jun Fu ◽

Wei Chai ◽

LiBo Hao ◽

Jiying 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 8.6mg/l in the uninfected group (p<0.001). The median of ESR was 34.8 mm/hr in the infected group and 17.4mm/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 46pg/ml and 6.4pg/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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Neutrophil to Lymphocyte Ratio as a predictor for diagnosis of early Periprosthetic Joint Infection

10.21203/rs.3.rs-23878/v2 ◽

2020 ◽

Author(s):

BaoZhan Yu ◽

Jun Fu ◽

Wei Chai ◽

LiBo Hao ◽

Jiying 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. Thediagnosis 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, 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 8.6mg/l in the uninfected group (p<0.001). The median of ESR was 34.8 mm/hr in the infected group and 17.4mm/hr in the uninfected group (p<0.001). In the infected group and uninfected group, the median of WBC was 8.2X10 9 /L and 6.1 X10 9 /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 46pg/ml and 6.4pg/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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Does serum interleukin-6 guide the diagnosis of persistent infection in two-stage hip revision for periprosthetic joint infection?

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1448-7 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Peng-Fei Qu ◽

Chi Xu ◽

Jun Fu ◽

Rui Li ◽

Wei Chai ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Interleukin 6 ◽

Persistent Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Roc Curves ◽

Two Stage ◽

Predictive Values ◽

Musculoskeletal Infection ◽

Significant Difference

Abstract Purpose The diagnosis of persistent infection at reimplantation of two-stage revision arthroplasty for periprosthetic joint infection (PJI) remains challenging. Several studies have shown the benefit of serum interleukin-6 (IL-6) in diagnosing periprosthetic joint infection (PJI). Recent data indicated serum IL-6 could be promising in differentiating persistent infection. The purpose of this study was to validate the efficacy of serum IL-6 in diagnosing persistent infection at reimplantation. Methods A retrospective review of 86 PJI patients with a two-stage exchanged hip arthroplasty from 2013 to 2017 was conducted. Persistent infection was defined using the modified Musculoskeletal Infection Society (MSIS) criteria combined with follow-up results. Serum IL-6 at reimplantation were collected and compared among patients with or without persistent infection. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic performance and optimal cut-off value of serum IL-6 at reimplantation. Results Sixteen cases were diagnosed as persistent infection at reimplantation. There was no significant difference in serum IL-6 levels between cases with persistent infection and controls (7.89 pg/ml vs. 5.56 pg/ml; P = 0.179). The area under the ROC curve (AUC) for serum IL-6 in diagnosing persistent infection at reimplantation was 0.59 (95% confidential interval [CI] 0.40–0.77). With the calculated threshold set at 8.12 pg/ml, the corresponding sensitivity, specificity, positive predictive value, and negative predictive values were 38%, 88%, 38%, and 87%, respectively. Conclusion Serum IL-6 is inadequate in diagnosing persistent infection at reimplantation for two-stage revision arthroplasty. With the serum IL-6 threshold set at 8.12 pg/ml, the specificity to rule out persistent infection is high, but the sensitivity to predict persistent infection is not satisfactory.

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Qualitative Alpha-defensin Versus The Main Available Tests For The Diagnosis Of Periprosthetic Joint Infection: Best Predictor Test?

Journal of Bone and Joint Infection ◽

10.7150/jbji.26401 ◽

2018 ◽

Vol 3 (3) ◽

pp. 156-164 ◽

Cited By ~ 11

Author(s):

Giovanni Riccio ◽

Luca Cavagnaro ◽

Wassim Akkouche ◽

Giuliana Carrega ◽

Lamberto Felli ◽

...

Keyword(s):

Likelihood Ratio ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Diagnostic Methods ◽

Minimal Amount ◽

Musculoskeletal Infection ◽

Infection Diagnosis ◽

Significant Difference

Abstract. Introduction: Biomarkers such as α-defensin demonstrated to be a potentially useful option in periprosthetic joint infection (PJI) diagnosis. Recently, a new point-of-care test for α-defensin level detection in synovial fluid has been commercialized in Europe. The aim of this study is to compare the α-defensin test (SynovasureTM) diagnostic ability with the main available clinical tests for periprosthetic joint infection diagnosis in a practical clinical setting of a Bone Infection Unit.Methods: Between 2015 and 2017, 146 patients with suspected chronic PJI were screened with SynovasureTM. Seventy-three of these met the Musculoskeletal Infection Society (MSIS) criteria and were included in the analysis. According to MSIS criteria, 40 patients (54.7%) were classified as infected and 33 (45.3%) as not infected. The results obtained with SynovasureTM were recorded and compared with standard diagnostic methods for PJI diagnosis.Results: SynovasureTM showed a sensitivity of 85.0 % (95% CI 70.2 to 94.3) and a specificity of 96.9 % (95% CI 83.8 to 99.9) for PJI detection. The positive likelihood ratio of SynovasureTM was 27.2 (95% CI 3.9 to 188.1) and the negative likelihood ratio was 0.2 (95% CI 0.1 to 0.3). The diagnostic odds ratio was 181.3 (95% CI 20.7 to 1590.4). SynovasureTM demonstrated a statistical significant difference when compared to Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) specificity (at least one positive test) and preoperative culture sensitivity (1 positive culture).Conclusion: Our findings show that SynovasureTM sensitivity is lower than quantitative α-D test, but when compared to the main available tests shows a good specificity and the highest DOR. On the SF it is the easier test to do, due to the fact that it needs a minimal amount of SF and it is not limited by blood contamination or antibiotic use. Whereas there is no single standalone test, SynovasureTM should be considered a reliable additional test for periprosthetic joint infection diagnosis in everyday clinical practice.

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Next-generation sequencing not superior to culture in periprosthetic joint infection diagnosis

The Bone & Joint Journal ◽

10.1302/0301-620x.103b1.bjj-2020-0017.r3 ◽

2021 ◽

Vol 103-B (1) ◽

pp. 26-31

Author(s):

Beau J. Kildow ◽

Sean P. Ryan ◽

Richard Danilkowicz ◽

Alexander L. Lazarides ◽

Colin Penrose ◽

...

Keyword(s):

Next Generation Sequencing ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Next Generation ◽

Sample Collection ◽

Tissue Samples ◽

Musculoskeletal Infection ◽

Conventional Culture ◽

Significant Difference ◽

Generation Sequencing

Aims Use of molecular sequencing methods in periprosthetic joint infection (PJI) diagnosis and organism identification have gained popularity. Next-generation sequencing (NGS) is a potentially powerful tool that is now commercially available. The purpose of this study was to compare the diagnostic accuracy of NGS, polymerase chain reaction (PCR), conventional culture, the Musculoskeletal Infection Society (MSIS) criteria, and the recently proposed criteria by Parvizi et al in the diagnosis of PJI. Methods In this retrospective study, aspirates or tissue samples were collected in 30 revision and 86 primary arthroplasties for routine diagnostic investigation for PJI and sent to the laboratory for NGS and PCR. Concordance along with statistical differences between diagnostic studies were calculated. Results Using the MSIS criteria to diagnose PJI as the reference standard, the sensitivity and specificity of NGS were 60.9% and 89.9%, respectively, while culture resulted in sensitivity of 76.9% and specificity of 95.3%. PCR had a low sensitivity of 18.4%. There was no significant difference based on sample collection method (tissue swab or synovial fluid) (p = 0.760). There were 11 samples that were culture-positive and NGS-negative, of which eight met MSIS criteria for diagnosing infection. Conclusion In our series, NGS did not provide superior sensitivity or specificity results compared to culture. PCR has little utility as a standalone test for PJI diagnosis with a sensitivity of only 18.4%. Currently, several laboratory tests for PJI diagnosis should be obtained along with the overall clinical picture to help guide decision-making for PJI treatment. Cite this article: Bone Joint J 2021;103-B(1):26–31.

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Predictive value of postoperative neutrophil-to-lymphocyte ratio on the early Periprosthetic joint infection after total joint arthroplasty: a pilot study

10.21203/rs.2.20200/v1 ◽

2020 ◽

Author(s):

Guang lei Zhao ◽

Jie Chen ◽

Jin Wang ◽

Siqun Wang ◽

Jun Xia ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Total Joint Arthroplasty ◽

Predictive Value ◽

Joint Infection ◽

Joint Arthroplasty ◽

Neutrophil To Lymphocyte Ratio ◽

Receiver Operating Curve ◽

Lymphocyte Ratio ◽

Normal White Blood Cell ◽

High Level

Abstract Objective : The purpose of this study was to evaluate the predictive value of the postoperative neutrophil-to-lymphocyte ratio on early periprosthetic joint infection. Methods : During the period from January 2008 to December 2016, 104 patients (26 early PJI cases and 78 non-PJI cases) who underwent total joint arthroplasty in the department of orthopedics in our Hospital were enrolled in our study. All of the relevant clinical information and laboratory indexes were reviewed from the our Hospital Follow-up system. The time when any abnormal symptoms or signs occurred including fever, local swelling or redness around the surgical site 2 weeks after the operations was defined as the “suspect time”. We compared the laboratory parameters including the NLR 、PLR、LMR、ESR and the CRP between the two groups. The trend of the NLR、LMR、PLR、CRP and ESR were also reviewed after the surgery. The predictive ability of these parameters at suspect time on the early PJI were evaluated by multivariate analysis and the Receiver operating curve analysis (ROC). Results : NLR, PLR and LMR returned to preoperative level within two weeks in two groups after surgery. In the early PJI group, NLR and PLR were significantly increased during the incubation period of infection or infection, LMR was significantly reduced, although 61.5% (16/26) of the patients had normal white blood cell. Interesting, the ESR and CRP were still in relative high level two weeks after the operation and the change of these two indexes was not obvious when the infection occurs. The NLR and PLR was significantly correlated with the early PJI (OR NLR =88.36, OR PLR =1.12, P NLR =0.005, P PLR =0.01) and the NLR has a great predict ability for early PJI with the cut-off value 2.77 (Sensitivity=84.6% ，Specificity=89.7%, 95% CI=0.86-0.97) Conclusions: ESR and CRP are not sensitive for diagnosis of early PJI due to their persistent high level after arthroplasty. The postoperative NLR at suspect time have a great ability in predicting early PJI and more attention should be applied to it.

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Benefits and Adverse Events Associated With Extended Antibiotic Use in Total Knee Arthroplasty Periprosthetic Joint Infection

Clinical Infectious Diseases ◽

10.1093/cid/ciz261 ◽

2019 ◽

Vol 70 (4) ◽

pp. 559-565 ◽

Cited By ~ 10

Author(s):

Neel B Shah ◽

Beverly L Hersh ◽

Alex Kreger ◽

Aatif Sayeed ◽

Andrew G Bullock ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Adverse Events ◽

Antibiotic Therapy ◽

Knee Arthroplasty ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Oral Antibiotics ◽

Significant Difference ◽

Total Knee ◽

Extended Course

Abstract Background Total knee arthroplasty (TKA) periprosthetic joint infection (PJI) can be managed with debridement, antibiotic therapy, and implant retention (DAIR). Oral antibiotics can be used after DAIR for an extended time period to improve outcomes. The objective of this study was to compare DAIR failure rates and adverse events between an initial course of intravenous antibiotic therapy and the addition of extended treatment with oral antibiotics. Methods A multicenter observational study of patients diagnosed with a TKA PJI who underwent DAIR was performed. The primary outcome of interest was the failure rate derived from the survival time between the DAIR procedure and future treatment failure. Results One hundred eight patients met inclusion criteria; 47% (n = 51) received an extended course of oral antibiotics. These patients had a statistically significant lower failure rate compared to those who received only intravenous antibiotics (hazard ratio, 2.47; P = .009). Multivariable analysis demonstrated that extended antibiotics independently predicted treatment success, controlling for other variables. There was no significant difference in failure rates between an extended course of oral antibiotics less or more than 12 months (P = .23). No significant difference in the rates of adverse events was observed between patients who received an initial course of antibiotics alone and those who received a combination of initial and extended antibiotic therapy (P = .59). Conclusions Extending therapy with oral antibiotics had superior infection-free survival for TKA PJI managed with DAIR. There was no increase in adverse events, demonstrating safety. After 1 year, there appears to be no significant benefit associated with continued antibiotic therapy.

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