Diagnóstico precoce da infecção articular periprotética do quadril – situação atual, avanços e perspectivas

Gomes, Luiz Humberto

doi:10.1055/s-0039-1693138

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…The treatment algorithm differentiated between early infections (EI), acute late infections (ALI), and chronic infections (CI), and was adapted from proposed definitions and classifications as described in the literature [ 2 , 7 , 21 ]. Symptoms persisting for less than 4 weeks were classified as acute infections, while symptoms extending beyond 4 weeks were classified as chronic infections (CI).…”

Section: Methodsmentioning

confidence: 99%

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Youssef,

Roschke,

Dietze

et al. 2024

Antibiotics

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Periprosthetic joint infections (PJI) are serious complications after arthroplasty, associated with high morbidity, mortality, and complex treatment processes. The outcomes of different PJI entities are largely unknown. The aim of this study was to access the early outcomes of different PJI entities. A retrospective, single-center study was conducted. The characteristics and outcomes of patients with PJI treated between 2018 and 2019 were evaluated 12 months after the completion of treatment. Primary endpoints were mortality, relapse free survival (RFS) and postoperative complications (kidney failure, sepsis, admission to ICU). A total of 115 cases were included [19.1% early (EI), 33.0% acute late (ALI), and 47.8% chronic infections (CI)]. Patients with ALI were older (p = 0.023), had higher ASA scores (p = 0.031), preoperative CRP concentrations (p = 0.011), incidence of kidney failure (p = 0.002) and sepsis (p = 0.026). They also tended towards higher in-house mortality (ALI 21.1%, 13.6% EI, 5.5% CI) and admission to ICU (ALI 50.0%, 22.7% EI, 30.9% CI). At 12 months, 15.4% of patients with EI had a relapse, compared to 38.1% in ALI and 36.4% in CI. There are differences in patient characteristics and early outcomes between PJI entities. Patients with EI have better early clinical outcomes. Patients with ALI require special attention during follow-up because they have higher occurrences of relapses and postoperative complications than patients with EI and CI.

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Section: Methodsmentioning

confidence: 99%

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Youssef,

Roschke,

Dietze

et al. 2024

Antibiotics

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“…IAPs são quaisquer infecções ao redor de próteses cirúrgicas inseridas em regiões articulares, em que as próteses tenham sido causa desse problema, no entanto ainda não há um consenso universal sobre os critérios diagnósticos que as definem (3) . Fatores como má nutrição, obesidade, idade avançada, diabetes mellitus, artrite reumatoide, psoríase, infecções anteriores, e depressão do sistema imune geram predisposição para o desenvolvimento de IAP (1) .…”

Section: Introductionunclassified

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INTRODUÇÃOAs próteses articulares são constantemente utilizadas como forma de melhorar a qualidade de vida da população envelhecida (1) , pois proporcionam melhor função articular e alívio de dores em pessoas que as necessitam. No entanto estão sujeitas a processos infecciosos, que são as infecções articulares periprotéticas (IAP), ocorrendo em 2.0-2.4% dos casos de intervenções primárias e 20% em procedimentos de revisão (2) .IAPs são quaisquer infecções ao redor de próteses cirúrgicas inseridas em regiões articulares, em que as próteses tenham sido causa desse problema, no entanto ainda não há um consenso universal sobre os critérios diagnósticos que as definem (3) . Fatores como má nutrição, obesidade, idade avançada, diabetes mellitus, artrite reumatoide, psoríase, infecções anteriores, e depressão do sistema imune geram predisposição para o desenvolvimento de IAP (1) .

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importância de leucócitos marcados no diagnóstico por imagem em infecções articulares periprotéticas / The value of labeled leukocytes imaging for periprosthetic joint infection diagnosis

Antunes¹,

Basso²

2023

Arq Med Hosp Fac Cienc Med Santa Casa São Paulo

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Introdução: A modalidade de imagem de leucócitos marcados é um dos métodos utilizados no diagnóstico de diversas infecções. Objetivo: O objetivo deste trabalho foi analisar a efetividade do exame no diagnóstico de infecções articulares periprotéticas e comparar com outros métodos diagnósticos. Métodos: Para realização da pesquisa foram consultadas as bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online e Google Acadêmico. Resultados: Os artigos publicados entre 2017-2022 mostraram que ainda há informações conflitantes, mas a cintilografia com leucócitos marcados é o exame com maior precisão diagnóstica de infecção articular periprotética. Conclusão: Foi constatado que a cintilografia com leucócitos marcados, em combinação com a tomografia por emissão de fóton único ou a cintilografia de medula óssea quando necessário, é o exame padrão ouro para o diagnóstico diferencial de infecções periprotéticas articulares até o presente estudo.Palavras-chaves: Cintilografia, Tc-99m HMPAO, Prótese articular, Infecções relacionadas à prótese, Leucócitos. ABSTRACT Introduction: Nuclear medicine is essential to identify physiological disorders. One of the applications is on imaging of labeled leukocytes, which allows to identify and assess infections. Objective: The objective of this work was to analyze, on a general basis, the effectiveness of the imaging of labeled leukocytes in infection diagnosis emphasizing periprosthetic joint infection. Methods: To carry out the research, papers were identified that matched the keywords on the databases Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online and Google Scholar. Results: The papers published in 2017–2022 stated that there are gaps to be filled, although labeled leukocytes scintigraphy represents the best accuracy. Conclusion: Labeled leukocytes scintigraphy, combined with bone marrow scintigraphy and single photon emission computed tomography when necessary, is the gold standard for differential diagnosisof periprosthetic joint infection.Keywords: Scintigraphy, Tc-99m HMPAO, Joint prosthesis, Prosthesis related infections, Leukocytes.

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“…This may last for years, even after successful surgical treatment [ 9 , 10 ]. Accordingly, a preference for an early and accurate diagnosis of PJI is one of the most accepted consensuses in orthopaedic surgery [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Microbiological Advantages of Open Incisional Biopsies for the Diagnosis of Suspected Periprosthetic Joint Infections

Niemann

Otto

Braun

et al. 2022

JCM

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Background: Periprosthetic joint infection (PJI) represents a serious complication following total hip (THA) and knee arthroplasty (TKA). When preoperative synovial fluid cultures remain inconclusive, open incisional joint biopsy (OIB) can support causative microorganism identification. Objective: This study investigates the potential benefit of OIB in THA and TKA patients with suspected PJI and ambigious diagnostic results following synovial fluid aspiration. Methods: We retrospectively assessed all patients treated from 2016 to 2020 with suspected PJI. Comparing the microbiology of OIB and the following revision surgery, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the number needed to treat (NNT). Results: We examined the diagnostic validity of OIB in 38 patients (20 female) with a median age of 66.5 years. In THA patients (n = 10), sensitivity was 75%, specificity was 66.67%, PPV was 60%, NPV was 80%, and NNT was 2.5. In TKA patients (n = 28), sensitivity was 62.5%, specificity was 95.24%, PPV was 83.33%, NPV was 86.96%, and NNT was 1.42. Conclusions: Our results indicate that OIB represents an adequate diagnostic tool when previously assessed microbiological results remain inconclusive. Particularly in TKA patients, OIB showed an exceptionally high specificity, PPV, and NPV, whereas the predictive validity of the diagnosis of PJI in THA patients remained low.

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Diagnóstico precoce da infecção articular periprotética do quadril – situação atual, avanços e perspectivas

Cited by 9 publications

References 29 publications

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

importância de leucócitos marcados no diagnóstico por imagem em infecções articulares periprotéticas / The value of labeled leukocytes imaging for periprosthetic joint infection diagnosis

Microbiological Advantages of Open Incisional Biopsies for the Diagnosis of Suspected Periprosthetic Joint Infections

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