Does the Alpha-defensin Immunoassay or the Lateral Flow Test Have Better Diagnostic Value for Periprosthetic Joint Infection? A Systematic Review

Eriksson, Hannah; Nordström, Jakob; Gabrysch, Katja; Hailer, Nils P; Lazarinis, Stergios

doi:10.1007/s11999.0000000000000244

Cited by 53 publications

(28 citation statements)

References 17 publications

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“…One assay is the enzyme-linked immunosorbent assay (ELISA), which is performed in a laboratory with results obtained within 24 h. The second assay is the lateral flow device, which rapidly detects infection within 20 min without the need for a laboratory. Accordingly, pooled results supported the higher sensitivity of the synovial fluid alpha-defensin ELISA compared to the lateral flow test [16,20,23,27] Sonicate fluid and periprosthetic tissue were performed most intraoperatively, whereas tissue PCR and sonicate fluid BCB were the most sensitive tests in tissue and sonicate fluid, respectively. In 2013, Qu et al [37] performed the first meta-analysis of PCR in the diagnosis of PJI.…”

Section: Discussionmentioning

confidence: 61%

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

Ojeda-Thies

et al. 2020

J Orthop Surg Res

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Background: Periprosthetic joint infection (PJI) is the most serious complication of joint replacement surgery. Further comorbidities include bedsore, deep vein thrombosis, reinfection, or even death. An increasing number of researchers are focusing on this challenging complication. The aim of the present study was to estimate global PJI research based on bibliometrics from meta-analysis studies. Methods: A database search was performed in PubMed, Scopus, and Web of Science. Relevant studies were assessed using the bibliometric analysis. Results: A total of 117 articles were included. The most relevant literature on PJI was found on Scopus. China made the highest contributions to global research, followed by the USA and the UK. The institution with the most contributions was the University of Bristol. The journal with the highest number of publications was The Journal of Arthroplasty, whereas the Journal of Clinical Medicine had the shortest acceptance time. Furthermore, the top three frequently used databases were Embase, MEDLINE, and Cochrane. The most frequent number of authors in metaanalysis studies was four. Most studies focused on the periprosthetic hip and knee. The alpha-defensin diagnostic test, preventive measures on antibiotics use, and risk factors of intra-articular steroid injections were the most popular topic in recent years. Conclusion: Based on the results of the present study, we found that there was no single database that covered all relevant articles; the optimal method for bibliometric analysis is a combination of databases. The most popular research topics on PJI focused on alpha-defensin, antibiotic use, risk factors of intra-articular steroid injections, and the location of prosthetic hip and knee infection.

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Section: Discussionmentioning

confidence: 61%

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

Ojeda-Thies

et al. 2020

J Orthop Surg Res

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“…Interestingly, the most popular diagnostic test applied in recent years was synovial fluid alpha-defensin, which also had the highest sensitivity. Accordingly, pooled results supported the higher sensitivity of the synovial fluid alpha-defensin immunoassay compared to the lateral flow test[14][15][16][17]. Preoperative tests with the lowest sensitivities were synovial fluid gram staining (GS), synovial fluid procalcitonin (PCT), serum white blood cells (WBCs), serum PCT, which were all found to have a sensitivity of less than 60%.…”

mentioning

confidence: 72%

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

Thies

et al. 2020

Preprint

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Background: Periprosthetic joint infection (PJI) is the most serious complication of joint replacement surgery. Further comorbidities include bedsore, deep vein thrombosis, reinfection, or even death. An increasing number of researchers are focusing on this challenging complication. The aim of the present study was to estimate global PJI research based on bibliometrics from meta-analysis studies. Methods: A database search was performed in PubMed, Scopus, and Web of Science. Relevant studies were assessed using the bibliometric analysis. Results: A total of 117 articles were included. The most relevant literature on PJI was found on Scopus. China made the highest contributions to global research, followed by the United States and the United Kingdom. The institution with the most contributions from the University of Bristol. The journal with the highest number of publications was The Journal of Arthroplasty, whereas the Journal of Clinical Medicine had the shortest acceptance time. The day of the week with the greatest number of received and accepted manuscripts was Wednesday. Furthermore, the top three frequently used databases were Embase, MEDLINE, and Cochrane. The most frequent number of authors in meta-analysis studies was four. Most studies focused on the periprosthetic hip and knee. The alpha-defensin diagnostic test, preventive measures on antibiotics use, and risk factors of intra-articular steroid injections were the most popular topic in recent years. Conclusion: Based on the results of the present study, we found that there was no single database covered all relevant articles, the optimal method for bibliometric analysis is a combination of databases. The most popular research topics on PJI focused on alpha-defensin, antibiotic use, risk factors of intra-articular steroid injections, and the location of prosthetic hip and knee infection. Alpha-defensin appears to be a reliable tool for the diagnosis of PJI.

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“…The Synovasure kit is a qualitative test with the striking advantage of being a point‐of‐care assay, performed intra‐operatively. However, in addition to being quite expensive, recent meta‐analysis showed that its sensitivity for the detection of PJIs in a real setting is lower than expected, 15–17 possibly due also to the test being performed by untrained personnel. In contrast, the low‐cost HNPs MALDI‐TOF MS assay requires shipping of the sample to the laboratory and is performed by experienced personnel, but still it has a short turn‐around time (TAT; as described above) which is theoretically compatible with an intra‐operative setting, just planning and coordinating the surgery with the clinical laboratory.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a number of meta‐analyses, focused on the different performance of these two analytical methods, have been published. The immunoassay for α‐defensin in SF has been reported to have the highest sensitivity (97.3–100%) and specificity (95.5–100%) compared with other single biomarkers of PJIs, 12,13 whereas the lateral flow test presents a lower sensitivity, ranging from 71% to 92.1%, and specificity from 89% to 100% 15–18 …”

Section: Introductionmentioning

confidence: 99%

Detection of α‐defensin in synovial fluids by matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry as an innovative and cost‐effective assay for improved definition of periprosthetic joint infections

Petrucca

Santino

Gentile

et al. 2020

Rapid Comm Mass Spectrometry

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Rationale:Detection of α-defensins in synovial fluid is gaining more and more interest in the field of correct diagnosis of periprosthetic joint infections (PJIs). At present, they can be assessed by a quantitative enzyme-linked immunosorbent assay which is expensive and time-consuming and by a qualitative lateral flow immunoassay which is rapid but quite expensive and whose clinical sensitivity is debated. Thus, developing an alternative rapid, accurate, and low-cost assay for α-defensins is important to make α-defensins actionable as novel key clinical markers. Methods: Synovial fluid (SF) samples were obtained from 18 patients undergoing revision of primary joint arthroplasty. Of these, eight met the 2013 Musculoskeletal Infection Society (MSIS) criteria for PJIs, the remaining were classified as aseptic failure. Microbiological analysis and Synovasure assays were carried out on all samples. Sample preparation and the matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) settings were adjusted to detect human neutrophil peptide (HNP)-1, -2 and -3 and to obtain optimal results in term of sensitivity and stability. Results: MALDI-TOF MS was able to detect HNPs in SF from septic patients. No signals for HNPs were detected in SF from aseptic failure. The limits of detection (LOD) were 2.5 and 1.25 μg/mL for HNP-2 and HNP-1, respectively. The turnaround time of the analysis is 20 min, and SF samples are stable at −20 C for up to 3 days.Assay sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were 100% for all parameters. On the same SF samples, the Synovasure assay showed lower sensitivity specificity, and PPV and NPV of 87.5%, 90%, 87.5% and 90%, respectively. Microbiological analysis of SF confirmed the presence of bacteria only in SF MSIS-positive patients. Conclusions:The reported MALDI-TOF MS assay was able to detect and differentiate HNPs in SF samples and showed a slightly better diagnostic accuracy than the Synovasure assay.

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Does the Alpha-defensin Immunoassay or the Lateral Flow Test Have Better Diagnostic Value for Periprosthetic Joint Infection? A Systematic Review

Abstract: Level III, diagnostic study.

Cited by 53 publications

References 17 publications

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

Detection of α‐defensin in synovial fluids by matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry as an innovative and cost‐effective assay for improved definition of periprosthetic joint infections

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