Synovial Fluid Biomarkers for the Diagnosis of Periprosthetic Joint Infection—A Systematic Review and Meta-Analysis of Their Diagnostic Accuracy According to Different Definitions

Vale, João; Castelo, Filipe; Barros, Bianca Sacramento; Ribau, Ana; Carvalho, André; Sousa, Ricardo

doi:10.1016/j.arth.2023.06.017

Cited by 8 publications

(4 citation statements)

References 45 publications

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“…Therefore, the two essays are not directly comparable; second, the sample size. In fact, in our study 65 PJI samples were analyzed compared to the 19 cases previously described; third, the use of the EBJIS diagnostic algorithm, which traditionally has shown less diagnostic consistency in the evaluation of other biomarkers ( Vale et al, 2023 ).…”

Section: Discussionmentioning

confidence: 99%

“…Several biomarkers derived from neutrophils, including leukocyte esterase (LE), alpha-defensin and calprotectin, have recently been evaluated as an aid in the diagnosis of PJI ( Renz et al, 2018 ; Grassi et al, 2022 ; Schindler et al, 2023 ). However, their diagnostic performance, is highly variable depending on the chosen PJI definition, with a poorer consistency with EBJIS criteria compared to Musculoskeletal Infection Society (MSIS) algorithm ( Vale et al, 2023 ). Moreover, the lack of standardized laboratory methods and universally accepted threshold values make their use difficult in clinical practice ( Hantouly et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

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Active myeloperoxidase: a promising biomarker to differentiate “acute” and “low-grade” peri-prosthetic joint infections from aseptic failures

Maritati,

De Rito,

Rosta

et al. 2024

Front. Microbiol.

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IntroductionThe accurate distinction between periprosthetic joint infections (PJI) and aseptic failures (AF) is of paramount importance due to differences in treatment. However, this could be challenging by using the current criteria. Various synovial fluid biomarkers are being assessed to improve the diagnostic accuracy. Myeloperoxidase (MPO), an enzyme contained in the granules of neutrophils, may be a promising biomarker for PJI.MethodsSynovial fluids of 99 patients (n = 65 PJI according to EBJIS criteria; n = 34 AF) were collected in two specialized orthopedic centers. PJI were divided into acute (n = 33) and low-grade (n = 32) according to previously published classification. An activity assay specific for active MPO was performed in each sample. Ability of MPO to correctly discriminate patients with PJI from AF was determined by ROC analysis. The best discriminating cut-off value was determined by calculating the J Youden index. For all analyses, a P value < 0.05 was considered statistically significant.ResultsActive MPO was higher in PJI than AF (P < 0.0001). The ROC analysis revealed a significant area under the curve (AUC: 0.86; 95% CI: 0.78–0.93, P < 0.0001). A cut-off value of 561.9 U/mL, with good sensitivity (0.69) and specificity (0.88), discriminated between AF and PJI (accuracy 75.76%, 95% CI: 66.11–83.81%, positive likelihood ratio 5.88, 95% CI: 2.31–14.98 and negative likelihood ratio 0.35, 95%CI: 0.24–0.51). No difference in MPO levels was found between acute and chronic low-grade PJI.ConclusionThe proposed assay appears to be a reliable and affordable tool for detecting the active MPO in synovial fluid, with promising characteristics of sensitivity and specificity in discriminating both acute and low-grade PJI from AF. Further studies are needed to confirm MPO diagnostic cut-off values and validate their use in the routine clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Active myeloperoxidase: a promising biomarker to differentiate “acute” and “low-grade” peri-prosthetic joint infections from aseptic failures

Maritati,

De Rito,

Rosta

et al. 2024

Front. Microbiol.

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“…[ 55 ] Synovial fluid can also be applied for biomarkers analysis, for example: alpha-defensin, leukocyte esterase, synovial fluid C-reactive protein, etc. Those common biomarkers come with high specificity and sensitivity, offering valuable information in PJI diagnosis [ 56 ]. According to Portillo et al, inoculating sonication fluid into blood culture bottles can enhance its diagnostic value.…”

Section: Microbiological Methods Of Diagnosing Biofilm Formation In O...mentioning

confidence: 99%

Modern Microbiological Methods to Detect Biofilm Formation in Orthopedy and Suggestions for Antibiotic Therapy, with Particular Emphasis on Prosthetic Joint Infection (PJI)

Mikziński,

Kraus,

Widelski

et al. 2024

Microorganisms

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Biofilm formation is a serious problem that relatively often causes complications in orthopedic surgery. Biofilm-forming pathogens invade implanted foreign bodies and surrounding tissues. Such a condition, if not limited at the appropriate time, often requires reoperation. This can be partially prevented by selecting an appropriate prosthesis material that prevents the development of biofilm. There are many modern techniques available to detect the formed biofilm. By applying them we can identify and visualize biofilm-forming microorganisms. The most common etiological factors associated with biofilms in orthopedics are: Staphylococcus aureus, coagulase-negative Staphylococci (CoNS), and Enterococcus spp., whereas Gram-negative bacilli and Candida spp. also deserve attention. It seems crucial, for therapeutic success, to eradicate the microorganisms able to form biofilm after the implantation of endoprostheses. Planning the effective targeted antimicrobial treatment of postoperative infections requires accurate identification of the microorganism responsible for the complications of the procedure. The modern microbiological testing techniques described in this article show the diagnostic options that can be followed to enable the implementation of effective treatment.

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“…Other synovial biomarkers have been discussed lately, including the C-reactive protein (CRP), Calprotectin, and α-Defensin. All three provide good diagnostic performance but are poorly harmonized (Calprotectin, α-Defensin) and may be misleading in cases of non-infectious joint inflammation [5]. So far, no alternative biomarker has emerged which has the potential to replace synovial cell count as the golden standard for the diagnosis of PJI.…”

Section: Introductionmentioning

confidence: 99%

Soluble Urokinase Plasminogen Activator Receptor (SuPAR) Analysis for Diagnosis of Periprosthetic Joint Infection

Klim,

Prattes,

Amerstorfer

et al. 2024

Antibiotics

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Soluble urokinase plasminogen activator receptors (suPARs) are a biomarker for inflammatory diseases. This study aims to investigate its diagnostic properties regarding periprosthetic joint infections (PJI). This retrospective cohort study included adult patients who underwent joint puncture for suspected PJI. The presence of PJI was determined according to the criteria of the European Bone and Joint Infection Society (EBJIS). Laboratory study analyses included the determination of white blood cells (WBC) in whole blood, C-reactive protein (CRP) in blood plasma, and suPAR in both blood plasma and synovial fluid. Appropriate diagnostic cut-off values were identified utilizing Youden’s J, and their diagnostic performance was determined by calculating the positive (PPV) and negative predictive value (NPV) for each marker. Sixty-seven cases were included in the final analysis. Forty-three samples (64%) were identified as periprosthetic joint infection (PJI) and twenty-four specimen (36%) were PJI negative cases. The PPV and NPV were 0.80 and 0.70 for synovial suPAR, 0.86 and 0.55 for CRP, 0.84 and 0.31 for WBC and 1.00 and 0.31 for plasma suPAR. Synovial suPAR showed a solid diagnostic performance in this study and has the potential to be an alternative or complementary biomarker for PJI. Further investigations in larger patient collectives are indicated.

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Synovial Fluid Biomarkers for the Diagnosis of Periprosthetic Joint Infection—A Systematic Review and Meta-Analysis of Their Diagnostic Accuracy According to Different Definitions

Cited by 8 publications

References 45 publications

Active myeloperoxidase: a promising biomarker to differentiate “acute” and “low-grade” peri-prosthetic joint infections from aseptic failures

Active myeloperoxidase: a promising biomarker to differentiate “acute” and “low-grade” peri-prosthetic joint infections from aseptic failures

Modern Microbiological Methods to Detect Biofilm Formation in Orthopedy and Suggestions for Antibiotic Therapy, with Particular Emphasis on Prosthetic Joint Infection (PJI)

Soluble Urokinase Plasminogen Activator Receptor (SuPAR) Analysis for Diagnosis of Periprosthetic Joint Infection

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