CORR Insights®: The Alpha-defensin Test for Periprosthetic Joint Infection Outperforms the Leukocyte Esterase Test Strip

Sheehan, Eoin

doi:10.1007/s11999-014-3794-4

Cited by 7 publications

(2 citation statements)

References 4 publications

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“…Notably, a recent meta-analysis [1] found the Elisa test superior, with the Synovasure ® being no better than other synovial markers such as C-reactive protein, interleukin-6 (IL-6), and leukocyte esterase. In any event, the results reported by Ecker et al are still inferior to the near 100% values reported for the hip and knee [4,13,14]. With a sensitivity of 75% (alpha-defensin) and 50% (leukocyte esterase), the findings of this study only support use of these markers as confirmatory for infection when positive, but leave us scratching our heads when they are not.…”

contrasting

confidence: 80%

CORR Insights®: What Is the Diagnostic Accuracy of Alpha-Defensin and Leukocyte Esterase Test in Periprosthetic Shoulder Infection?

Pearl

2019

Clin Orthop Relat Res

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S houlder arthroplasty surgeons, like myself, are currently in a quandary. We have more arthroplasty options than ever before and the ability to improve comfort and function for an expansive range of glenohumeral joint maladies. Accordingly, the number of shoulder replacements being performed has This CORR Insights ® is a commentary on the article "What Is the Diagnostic Accuracy of Alpha-Defensin and Leukocyte Esterase Test in Periprosthetic Shoulder Infection?" by Ecker and colleagues

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contrasting

confidence: 80%

CORR Insights®: What Is the Diagnostic Accuracy of Alpha-Defensin and Leukocyte Esterase Test in Periprosthetic Shoulder Infection?

Pearl

2019

Clin Orthop Relat Res

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“…The most attractive aspect of this biomarker immunoassay is that it is simple, provides a final result before surgical decisions are made, and is standardized and validated to provide equivalent results for all surgeons. Although there has been great interest in the alpha-defensin test for PJI in the recent literature [ 4 – 7 , 15 ], it is reasonable to question whether the alpha-defensin peptide is stimulated to the same extent by all organisms. On one hand, it may be desirable to have a differential alpha-defensin response to differing organisms, because organism identification may be possible.…”

Section: Discussionmentioning

confidence: 99%

The Alpha-defensin Test for Periprosthetic Joint Infection Responds to a Wide Spectrum of Organisms

Deirmengian

Kardos²,

Kyamanywa³

et al. 2015

Clinical Orthopaedics &Amp; Related Research

167

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BackgroundThe alpha-defensin test has been previously demonstrated to be highly accurate in the diagnosis of prosthetic joint infection (PJI), nearly matching the Musculoskeletal Infection Society definition for PJI. However, the relationship between alpha-defensin levels and differing infecting organism has not yet been investigated.Questions/purposesThe purpose of this study is to describe the breadth of organisms that can trigger a positive synovial fluid alpha-defensin test result in the setting of PJI and also to assess the magnitude of the alpha-defensin result in terms of various pathogen characteristics.MethodsBetween December 2012 and March 2014, one laboratory processed 2319 synovial fluid samples for alpha-defensin testing. The present study reviewed the results of the 1937 samples that simultaneously had a synovial fluid culture performed; these came from 418 surgeons in 42 states. The overall culture-positive rate was 49% (244 of 498) among alpha-defensin-positive synovial fluids and 1% (19 of 1439) among alpha-defensin-negative synovial fluids. The organisms recovered from 244 alpha-defensin-positive, culture-positive fluids were recorded and grouped based on various characteristics, including Gram type, species, virulence, oral pathogenicity, and source joint. Alpha-defensin-negative samples served as uninfected controls. Median alpha-defensin levels were calculated for each group, and Dunn’s multiple comparison test for nonparametric data was used to identify any statistically significant (p < 0.05) organism-specific differences in the alpha-defensin level.ResultsThe alpha-defensin test for PJI was positive in the setting of a wide spectrum of organisms typically causing PJI. The median alpha-defensin level for all 244 alpha-defensin-positive, culture-positive samples (4.7 [interquartile range {IQR}, 3.7–5.3]) was higher than negative controls (0.26 [IQR, 0.22–0.33]) with a median difference of 4.4 (p < 0.001). There were no differences in the median alpha-defensin levels when performing a multiple comparison test among Gram-positive organisms (4.7 [IQR, 3.6–5.3]), Gram-negative organisms (4.8 [IQR, 4.2–5.3]), yeast (4.1 [IQR, 2.2–5.1]), virulent organisms (4.7 [IQR, 3.8–5.2]), less virulent organisms (4.8 [IQR, 3.6–5.4]), oral pathogens (4.5 [IQR, 3.2–5.2]), knees (4.7 [IQR, 3.7–5.3]), hips (4.9 [IQR, 4.1–5.8]), or shoulders (5.3 [IQR, 4.0–10.7]) with all comparisons having a p > 0.999.ConclusionsThe alpha-defensin test provides consistent results regardless of the organism type, Gram type, species, or virulence of the organism and should be seriously considered to be a standard diagnostic tool in the evaluation for PJI. Future research should focus on the performance of this test in specific clinical scenarios such as the immediate postoperative period in the setting of severe immunocompromise and in the setting of a native joint.Level of EvidenceLevel III, diagnostic study.

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Leukocyte esterase analysis in the diagnosis of joint infection: Can we make a diagnosis using a simple urine dipstick?

et al. 2015

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CORR Insights®: The Alpha-defensin Test for Periprosthetic Joint Infection Outperforms the Leukocyte Esterase Test Strip

Cited by 7 publications

References 4 publications

CORR Insights®: What Is the Diagnostic Accuracy of Alpha-Defensin and Leukocyte Esterase Test in Periprosthetic Shoulder Infection?

CORR Insights®: What Is the Diagnostic Accuracy of Alpha-Defensin and Leukocyte Esterase Test in Periprosthetic Shoulder Infection?

The Alpha-defensin Test for Periprosthetic Joint Infection Responds to a Wide Spectrum of Organisms

Leukocyte esterase analysis in the diagnosis of joint infection: Can we make a diagnosis using a simple urine dipstick?

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