Accuracy and Cost-Effectivenss of a Novel Method for Alpha Defensins Measurement in the Diagnosis of Periprosthetic Joint Infections

Iorio, Raffaele; Viglietta, Edoardo; Mazza, Daniele; Petrucca, Andrea; Borro, Marina; Santino, Iolanda; Simmaco, Maurizio; Ferretti, Andrea

doi:10.1016/j.arth.2021.05.013

Cited by 10 publications

(10 citation statements)

References 43 publications

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“…Their investigation also described the technical details of the procedure, and the pros and cons of the novel test. We subsequently published a recent study to assess the clinical utility of MALDI-TOF MS as an innovative diagnostic test for PJI on a large series of patients undergoing THA or TKA revision 28 . An overall accuracy of 94.9, 93% sensitivity, and 96% specificity were found.…”

Section: Discussionmentioning

confidence: 99%

“…Nowadays, MALDI-TOF MS is an increasingly available technology in clinical laboratories, and it has been recently validated as an innovative test for the diagnosis of PJI. Compared to the other two commercially available alpha-defensin tests, MALDI-TOF MS has shown not be affected by blood contamination or cellular debris, and is markedly less expensive than the others (0.73 euro is the estimated cost per sample) 28 . Cost-effectiveness represents a major advantage of the test, which may contribute to the widespread use of MAL-DI-TOF MS for diagnosis of PJI.…”

Section: Discussionmentioning

confidence: 99%

“…In the last few years, the efforts of the orthopedic community sought to improve diagnosis of PJIs by introducing a diagnostic algorithm and proposing innovative tests and biomarkers [13][14][15] . Among these, synovial fluid alpha-defensins have shown promising results [16][17][18][19][20][21][22][23][24][25][26][27][28] , and their detection has been introduced in the most recent definition of PJIs developed by the Musculoskeletal Infection Society (MSIS) 29 . Measurement of alpha-defensins in synovial fluid may be challenging if performed with the two commercially available methods (i.e.…”

Section: Introductionmentioning

confidence: 99%

“…In fact, the ELISA is expensive, and time-consuming, while the lateral flow test has less accuracy and is also costly [16][17][18][19][20][21][22][23][24][25][26][27] . Novel diagnostic tests for detection of alpha-defensins in synovial fluids have been recently proposed with interesting results 28,30,31 . Among these, the method based on matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is expected to be readily introduced in the clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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Acute peri-prosthetic joint infection: improving diagnosis through the novel alpha-defensins test

Iorio

Viglietta²,

Mazzà³

et al. 2022

Lo Scalpello

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Background. The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has recently been proposed as novel alpha-defensins test for diagnosis of peri-prosthetic joint infections (PJIs). The aim of the current study is to assess the diagnostic accuracy of alpha-defensins MALDI-TOF MS in case of acute PJIs. Methods. This prospective study included a series of 10 consecutive patients affected by PJIs according to the 2018 MSIS criteria. Synovial fluids were assessed for routine synovial fluid tests and alpha-defensins measurement with MALDI-TOF MS. Sensitivity, specificity, positive, and negative predictive values (PPV and NPV) were assessed. Results. Six females and 4 males with acute PJIs were included. The mean age was 72.5 (range 67-79), and the mean time elapsed from primary arthroplasty to PJIs was 52 days (range 13-90). Eight TKA and 2 THA were evaluated. The involved bacteria were Staphylococcus aureus in 4 patients, coagulase-negative Staphylococcus species in 3 patients, Enterococcus species in 3 patients, and Pseudomonas aeruginosa in 1 patient. Three cases were characterized by polymicrobial infection. The MALDI-TOF alpha-defensin test correctly identified all 10 patients with acute PJIs. According to the current preliminary results the MALDI-TOF assay showed a 100% sensitivity, specificity, PPV, and NPV. Conclusions. The novel alpha-defensins MALDI-TOF MS test showed promising results with high sensitivity and specificity in the diagnosis of acute PJIs. The reliability of the test in case of acute PJI could allow surgeons to manage the infection with a less invasive procedure with several advantages for patients. The findings of the present study seemed to confirm that the novel assay, which needs only few milliliters of sample, provides rapid results, and has substantial cost-effectiveness, and thus may be a useful diagnostic tool in clinical practice, even in case of acute PJIs. Further studies are needed to confirm these results on a larger series of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Acute peri-prosthetic joint infection: improving diagnosis through the novel alpha-defensins test

Iorio

Viglietta²,

Mazzà³

et al. 2022

Lo Scalpello

Self Cite

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“…A recent study evaluated MALDI-TOF MS as a technique to measure alpha defensin in synovial fluid. Iorio et al ( 53 ) evaluated samples from 138 patients undergoing revision for either infective or aseptic cause and found that detection of alpha defensin using MALDI-TOF MS had a sensitivity and specificity of 93% and 98%, respectively, using 2018 MSIS criteria as the reference standard. They did not compare the accuracy of this method with that of either lateral flow or ELISA in the study samples, and further study with larger case numbers is required to determine the reliability and reproducibility of MALDI-TOF MS in measurement of alpha defensin in synovial fluid.…”

Section: Detection Of Host Responsementioning

confidence: 99%

Enhancing Diagnostics in Orthopedic Infections

2022

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Accurate diagnosis of orthopedic infection is crucial in guiding both antimicrobial therapy and surgical management in order to optimize patient outcomes. A variety of microbiological and nonmicrobiological methods are used to establish the presence of a musculoskeletal infection. In this minireview, we examine traditional culture-based and newer molecular methodologies for pathogen detection, as well as systemic and localized assays to assess host response to maximize diagnostic yield.

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Synovial Fluid Biomarkers for the Diagnosis of Periprosthetic Joint Infection—A Systematic Review and Meta-Analysis of Their Diagnostic Accuracy According to Different Definitions

Vale¹,

Castelo²,

Barros³

et al. 2023

The Journal of Arthroplasty

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Accuracy and Cost-Effectivenss of a Novel Method for Alpha Defensins Measurement in the Diagnosis of Periprosthetic Joint Infections

Cited by 10 publications

References 43 publications

Acute peri-prosthetic joint infection: improving diagnosis through the novel alpha-defensins test

Acute peri-prosthetic joint infection: improving diagnosis through the novel alpha-defensins test

Enhancing Diagnostics in Orthopedic Infections

Synovial Fluid Biomarkers for the Diagnosis of Periprosthetic Joint Infection—A Systematic Review and Meta-Analysis of Their Diagnostic Accuracy According to Different Definitions

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