“Alpha Defensin-1 Biomarker Outperforms Culture in Diagnosing Breast Implant-Related Infection: Results from a Multicenter Prospective Study.”

Abstract

Background: Prompt diagnosis of breast implant infection is critical to reducing morbidity. A high incidence of false-negative microbial culture mandates superior testing modalities. Alpha defensin-1 (AD-1), an infection biomarker, has outperformed culture in diagnosing periprosthetic joint infection with sensitivity/specificity of 97%. After previously demonstrating its feasibility in breast implant-related infection (BIRI), this case-control study compares the accuracy of AD-1 to microbial culture in suspected BIRI. Methods: An institutional review board-approved, prospective, multicenter study was conducted of adults with prior breast implant reconstruction undergoing surgery for suspected infection (cases) or prosthetic exchange/revision (controls). Demographics, perioperative characteristics, antibiotic exposure, and implant pocket fluid were collected. Fluid samples underwent microbial culture, AD-1 assay, and adjunctive markers (C-reactive protein, lactate, cell differential); diagnostic performance was assessed by means of sensitivity, specificity, and accuracy from receiver operating characteristic curve analysis, with values of P < 0.05 considered significant. Results: Fifty-three implant pocket samples were included (cases, n = 20; controls, n = 33). All 20 patients with suspected BIRI exhibited cellulitis, 65% had abnormal drainage, and 55% were febrile. All suspected BIRIs were AD-1 positive (sensitivity, 100%). Microbial culture failed to grow any microorganisms in four BIRIs (sensitivity, 80%; P = 0.046); Gram stain was least accurate (sensitivity, 25%; P < 0.001). All tests demonstrated 100% specificity. Receiver operating characteristic curve analyses yielded the following areas under the curve: AD-1, 1.0; microbial culture, 0.90 (P = 0.029); and Gram stain, 0.62 (P < 0.001). Adjunctive markers were significantly higher among infections versus controls (P < 0.001). Conclusions: Study findings confirm the accuracy of AD-1 in diagnosing BIRI and indicate superiority to microbial culture. Although further study is warranted, AD-1 may facilitate perioperative decision-making in BIRI management in a resource-efficient manner.

WITHDRAWN: Alpha Defensin-1 Level Correlates with Peri-Prosthetic Infection Severity following Implant-Based Breast Reconstruction

“…In fact, AD-1 has become a critical component in the diagnosis of prosthetic joint infection following orthopaedic intervention, as it is routinely found within infected periimplant uid collections and remains uniquely unchanged in the setting of indolent infections or previous antibiotic exposure [9][10][11][12]. Its use in the diagnosis of breast implant-associated infection remains limited; however, in a previous study performed by our group, we demonstrated superior sensitivity and speci city of AD-1 in the identi cation of peri-prosthetic breast infection when compared to standard bacterial culture [13,14].…”

“…Whereas AD-1 stands to supplant bacterial culture as a point-of-care resource to identify peri-prosthetic infection, there remains a gap in our ability to differentiate between mild, moderate, and severe infections with current diagnostic tools [8,13]. It stands to reason that relative AD-1 concentrations within uid samples may serve as a surrogate marker for the extent of pathogenic metabolic activity and innate in ammatory response, thereby demonstrating utility as a marker of infection severity.…”

Alpha Defensin-1 Level Correlates with Periprosthetic Infection Severity following Implant-based Breast Reconstruction

“…13,14 Whereas AD-1 stands to supplant bacterial culture as a point-of-care resource to identify periprosthetic infection, there remains a gap in our ability to differentiate between mild, moderate, and severe infections with current diagnostic tools. 8,13 It stands to reason that relative AD-1 concentrations within fluid samples may serve as a surrogate marker for the extent of pathogenic metabolic activity and innate inflammatory response, thereby demonstrating utility as a marker of infection severity. The aim of this study is to evaluate the relationship between quantitative AD-1 levels and infection severity in patients who present with suspected periprosthetic infection.…”

“…9–12 Its use in the diagnosis of breast implant-associated infection remains limited; however, in two prior studies performed by our group, we demonstrated superior sensitivity and specificity of AD-1 in the identification of periprosthetic breast infection when compared with standard bacterial culture or Gram stain. 13,14…”

“…[9][10][11][12] Its use in the diagnosis of breast implant-associated infection remains limited; however, in two prior studies performed by our group, we demonstrated superior sensitivity and specificity of AD-1 in the identification of periprosthetic breast infection when compared with standard bacterial culture or Gram stain. 13,14 Whereas AD-1 stands to supplant bacterial culture as a point-of-care resource to identify periprosthetic infection, there remains a gap in our ability to differentiate between mild, moderate, and severe infections with current diagnostic tools. 8,13 It stands to reason that relative AD-1 concentrations within fluid samples may serve as a surrogate marker for the extent of pathogenic metabolic activity and innate inflammatory response, thereby demonstrating utility as a marker of infection severity.…”