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

Colvin, Otis C.; Kransdorf, Mark J.; Roberts, Catherine C.; Chivers, F. Spencer; Lorans, Roxanne; Beauchamp, C.P.; Schwartz, Adam J.

doi:10.1007/s00256-015-2097-5

Cited by 66 publications

(47 citation statements)

References 34 publications

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“…here were 10 articles reporting 11 evaluations 13,14,17,18,[26][27][28][29][30][31] that contributed to our estimates of diagnostic accuracy for both tests. Six studies explored the diagnostic accuracy of alpha-defensin for PJI 13,17,[26][27][28]31 , while the remaining 5 studies explored the diagnostic accuracy of leukocyte esterase for PJI 14,17,18,29,30 .…”

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confidence: 99%

“…Six studies explored the diagnostic accuracy of alpha-defensin for PJI 13,17,[26][27][28]31 , while the remaining 5 studies explored the diagnostic accuracy of leukocyte esterase for PJI 14,17,18,29,30 . Study characteristics are summarized in Table III. All of the included studies were published within the last 5 years and originated from the U.S.…”

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confidence: 99%

“…When details were provided, the mean ages of patients in these studies ranged from 61 to 67 years and 43% to 48% were male. In the studies of leukocyte esterase, all investigations included patients who had knee arthroplasty 14,17,18,29,30 , 4 studies included patients who had hip arthroplasty 17,18,29,30 , and 1 study also included patients who had elbow or ankle arthroplasty 29 . The mean ages of the patients ranged from 63 to 69 years, and 43% to 48% were male.…”

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confidence: 99%

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The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection

Wyatt

Beswick

Kunutsor

et al. 2016

The Journal of Bone and Joint Surgery

179

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Background: Synovial biomarkers have recently been adopted as diagnostic tools for periprosthetic joint infection (PJI), but their utility is uncertain. The purpose of this systematic review and meta-analysis was to synthesize the evidence on the accuracy of the alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of PJI compared with the Musculoskeletal Infection Society diagnostic criteria. Methods: We performed a systematic review to identify diagnostic technique studies evaluating the accuracy of alpha-defensin or leukocyte esterase in the diagnosis of PJI. MEDLINE and Embase on Ovid, ACM, ADS, arXiv, CERN DS (Conseil Européen pour la Recherche Nucléaire Document Server), CrossRef DOI (Digital Object Identifier), DBLP (Digital Bibliography & Library Project), Espacenet, Google Scholar, Gutenberg, HighWire, IEEE Xplore (Institute of Electrical and Electronics Engineers digital library), INSPIRE, JSTOR (Journal Storage), OAlster (Open Archives Initiative Protocol for Metadata Harvesting), Open Content, Pubget, PubMed, and Web of Science were searched for appropriate studies indexed from inception until May 30, 2015, along with unpublished or gray literature. The classification of studies and data extraction were performed independently by 2 reviewers. Data extraction permitted meta-analysis of sensitivity and specificity with construction of receiver operating characteristic curves for each test. Results: We included 11 eligible studies. The pooled diagnostic sensitivity and specificity of alpha-defensin (6 studies) for PJI were 1.00 (95% confidence interval [CI], 0.82 to 1.00) and 0.96 (95% CI, 0.89 to 0.99), respectively. The area under the curve (AUC) for alpha-defensin and PJI was 0.99 (95% CI, 0.98 to 1.00). The pooled diagnostic sensitivity and specificity of leukocyte esterase (5 studies) for PJI were 0.81 (95% CI, 0.49 to 0.95) and 0.97 (95% CI, 0.82 to 0.99), respectively. The AUC for leukocyte esterase and PJI was 0.97 (95% CI, 0.95 to 0.98). There was substantial heterogeneity among studies for both diagnostic tests. Conclusions: The diagnostic accuracy for PJI was high for both tests. Given the limited number of studies and the large cost difference between the tests, more independent research on these tests is warranted. Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection

Wyatt

Beswick

Kunutsor

et al. 2016

The Journal of Bone and Joint Surgery

179

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“…They reported that ++ was considered as the positive result, and the sensitivity and specificity were 80.6% and 100%, respectively, with a PPV and NPV of 100% and 93.3%, respectively [8]. Since then, Aggarwal et al [12], Wetters et al [21], Nelson et al [22], Colvin et al [10], and De Vecchi et al [23] have reported the use of the LE strip in the diagnosis of PJI. However, two cut-off values (++ or ++/+) have been used in these above-mentioned studies, although they used the same kind of LE strip.…”

Section: Discussionmentioning

confidence: 99%

Leukocyte Esterase as a Biomarker in the Diagnosis of Periprosthetic Joint Infection

Wang

et al. 2017

Med Sci Monit

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BackgroundTotal joint arthroplasty (TJA) has been one of the most rewarding interventions for treating patients suffering from joint disorders. However, periprosthetic joint infection (PJI) is a serious complication that frequently accompanies TJA. Our study aimed to investigate the application of the leukocyte esterase (LE) strip in the diagnosis of PJI.Material/MethodsFrom October 2014 to July 2015, 72 patients who had undergone joint puncture after arthroplasty in our hospital were enrolled in this trial. One drop of synovial fluid from each available patient was applied to the LE strip, and the results were observed after 1–3 min. If the color turned to dark purple, we recognized this as a positive result, while other colors were regarded as negative results. Centrifugation was used when the synovial fluid was mixed with blood. The Musculoskeletal Infection Society (MSIS) definition was used as the standard reference to identify whether PJI was found in patients or not. The results of diagnosis and LE strips test were compared, and indicators reflecting diagnostic value were calculated. Correlation of the LE data with erythrocyte sedimentation rate (ESR), elevated C-reactive protein (CRP), synovial white blood cell (WBC) counts, and polymorphonuclear neutrophil (PMN) percentage was calculated.ResultsBy MSIS criteria, 38 patients were diagnosed with PJI and 34 patients were not infected. Two types of LE strip presented the same results with sensitivity of 84.21% (95% confidence interval [CI]: 68.75~93.98%), specificity of 97.06% (95% CI: 84.67~99.93%), positive predictive value (PPV) of 96.97% (95% CI: 84.24~99.92%), and negative predictive value (NPV) of 84.62% (95% CI: 69.47~94.14%). There were one false-positive case and six false-negative cases in this trial. There is a strong correlation between LE strip and synovial fluid PMN percentage.ConclusionsThe sensitivity and specificity of the LE strip in the diagnosis of PJI are quite high, which means the LE strip might be used as an alternative to diagnose PJI in clinical practice.

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“…showed a sensitivity of 80.6% and a specificity of 100% with a leukocyte ++ reading 21. The sensitivity of 100% and a specificity of 97% were demonstrated more recently with a leukocyte ++ reading by Colvin et al 22. LER testing is quick, relatively sensitive, and cheap.…”

Section: Joint Aspiration and Synovial Fluid Analysismentioning

confidence: 91%

Management of the Infected Total Hip Arthroplasty

Lopez

Leach

Moore

et al. 2017

IJOO

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In the United Kingdom approximately 80,000 total hip arthroplasties are undertaken on an average each year. The popularity and demand for this operation are continually increasing. Our understanding of arthroplasty surgery and its complications has evolved greatly, and as a result infection rates are undeniably at an all-time low. The increasing volume of operations being performed does, however, mean that we still continue to see an increased number of cases of infection. There is no doubt that periprosthetic joint infection (PJI) poses a complex clinical and diagnostic predicament to clinicians. Delay in the diagnosis and treatment of PJI can not only be detrimental in terms of patient morbidity, but it also poses a significant financial burden to health care institutions. It is therefore in the best interest of the patient, surgeon, and institution to optimize the diagnosis and treatment of this devastating complication. There remains considerable variability in terms of approach to diagnosis and treatment of PJI among orthopedic surgeons. In this review, we will, therefore, examine in detail the current body of evidence available on PJI. We will discuss the most robust and up-to-date methods of diagnosis and offer a comparison of management strategies.

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

Cited by 66 publications

References 34 publications

The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection

The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection

Leukocyte Esterase as a Biomarker in the Diagnosis of Periprosthetic Joint Infection

Management of the Infected Total Hip Arthroplasty

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