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Liu D, Xiao WF, Li YS. The Diagnostic and Prognostic Value of Synovial Fluid Analysis in Joint Diseases. Methods Mol Biol 2023; 2695:295-308. [PMID: 37450127 DOI: 10.1007/978-1-0716-3346-5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Liquid biopsy is an emergent test method for the diagnosis and prognosis in the clinic. Joint fluid, also known as synovial fluid, contains a variety of bioactive constituents that can be selectively detected and further evaluated in a convenient fashion. Therefore, synovial fluid analysis functions as a specific form of liquid biopsy and plays a vital role in numerous joint diseases. In spite of the component analysis of aspirated synovial fluid beingconsidered as the gold standard for diagnosis of joint infections, biopsy of joint fluid benefits the initial diagnosis and long-term prognosis of degenerative, inflammatory, autoimmune, traumatic, congenital, and even neoplastic joint diseases. The convenience and accuracy for disease evaluation are significantly elevated as a result of the combination of synovial fluid analysis and other novel clinical technologies. In this review, we shed light on the latent role of synovial fluid in the diagnosis and prognosis of articular diseases and proposed future prospects for relevant research in this field.
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Affiliation(s)
- Di Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wen-Feng Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yu-Sheng Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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2
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Xará-Leite F, Ribau A, Lopes Guerra MD, Abreu MA, Rodrigues-Pinto R. Multidisciplinary Approach to Multiple Multiresistant Agent Infection of Instrumented Spine Surgery: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00029. [PMID: 35081062 DOI: 10.2106/jbjs.cc.21.00472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report the case of a patient with consecutive infections with several multidrug-resistant agents-including carbapenem-resistant strains of Klebsiella pneumoniae among others-from a surgical wound infection after lumbar spine fusion, only successfully treated after the resort to novel antibiotics (ceftazidime-avibactam) in combination therapy. CONCLUSIONS Multidrug resistance has become a major challenge in today's medicine. Care should be taken to avoid their emergence, but when present, a multidisciplinary approach is mandatory to ensure clinically up-to-date treatment choices. Multimodal antibiotic schemes tend to show the most promising results, with which successful infection resolution can still be achieved.
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Affiliation(s)
- Francisco Xará-Leite
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal.,School of Medicine, University of Minho, Braga, Portugal
| | - Ana Ribau
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | | | - Miguel Araújo Abreu
- Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
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3
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Auñón Á, Coifman I, Blanco A, García Cañete J, Parrón-Cambero R, Esteban J. Usefulness of a Multiplex PCR Assay for the Diagnosis of Prosthetic Joint Infections in the Routine Setting. Orthop Surg 2022; 14:383-388. [PMID: 34978153 PMCID: PMC8867406 DOI: 10.1111/os.13187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/14/2021] [Accepted: 11/19/2021] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the usefulness of a multiplex polymerase chain reaction (PCR) assay as a complementary tool in the diagnosis of prosthetic joint infections in the routine setting of a clinical microbiology laboratory, with a special focus on patients at high risk of culture‐negative infections and high suspicion of infection. Methods The results obtained in the routine care setting with the use of the commercial multiplex PCR (Unyvero i60©, Curetis AG, Holzgerlingen, Germany) were retrospectively reviewed. The test was performed in samples of patients with suspected prosthetic joint infection, which were also processed for conventional diagnostic methods, including sonication of the implant when possible. Patients selected for the test were those with negative cultures after a 24‐h incubation period. Results Ninety‐nine PCRs were performed, 57 of which were diagnostic of infection according to 2018 MSIS criteria. Nine patients received antibiotics within the 15 days prior to the diagnostic procedure. Tested samples included synovial fluid (33), sonication fluid (56) and tissue biopsies (10). The PCR test detected microorganisms in 26 samples: including two cases of polymicrobial infection. Eleven patients were diagnosed by using PCR only. The most frequently detected microorganism in PCR was Coagulase‐Negative Staphylococcus in 11 samples, followed by Staphylococcus aureus in five. One sample was positive for the bacteria universal primer, included in the 2.0 version of the kit. Only one discrepancy was detected between a negative PCR and a positive culture. One sample was also positive for a resistance marker (detection of mecA gene in a case of methicillin‐resistant S. aureus infection). Conclusion The incorporation of the Unyvero ITI multiple PCR technique in patients selected by clinical experts is a useful tool for the diagnosis of bone and joint infections in a routine care setting. A close clinical‐microbiological collaboration improves the usefulness of this kit for the management of patients with these infections.
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Affiliation(s)
- Álvaro Auñón
- Department of Orthopedic Surgery, Bone and Joint Infection Unit, IIS-Fundacion Jimenez Diaz, Madrid, Spain.,Networking Research Centre on Infectious Diseases (CIBER de Enfermedades Infecciosas), Madrid, Spain
| | - Ismael Coifman
- Department of Orthopedic Surgery, Bone and Joint Infection Unit, IIS-Fundacion Jimenez Diaz, Madrid, Spain
| | - Antonio Blanco
- Networking Research Centre on Infectious Diseases (CIBER de Enfermedades Infecciosas), Madrid, Spain.,Internal Medicine-Emergencies, Bone and Joint Infection Unit, IIS-Fundacion Jimenez Diaz, Madrid, Spain
| | - Joaquín García Cañete
- Internal Medicine-Emergencies, Bone and Joint Infection Unit, IIS-Fundacion Jimenez Diaz, Madrid, Spain
| | - Raúl Parrón-Cambero
- Department of Orthopedic Surgery, Bone and Joint Infection Unit, IIS-Fundacion Jimenez Diaz, Madrid, Spain.,Networking Research Centre on Infectious Diseases (CIBER de Enfermedades Infecciosas), Madrid, Spain
| | - Jaime Esteban
- Networking Research Centre on Infectious Diseases (CIBER de Enfermedades Infecciosas), Madrid, Spain.,Clinical Microbiology, Bone and Joint Infection Unit, IIS-Fundacion Jimenez Diaz, Madrid, Spain
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4
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Tai DBG, Wengenack NL, Patel R, Berbari EF, Abdel MP, Tande AJ. Fungal and mycobacterial cultures should not be routinely obtained for diagnostic work-up of patients with suspected periprosthetic joint infections. Bone Joint J 2022; 104-B:53-58. [PMID: 34969277 DOI: 10.1302/0301-620x.104b1.bjj-2021-0876.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS Fungal and mycobacterial periprosthetic joint infections (PJI) are rare events. Clinicians are wary of missing these diagnoses, often leading to the routine ordering of fungal and mycobacterial cultures on periprosthetic specimens. Our goal was to examine the utility of these cultures and explore a modern bacterial culture technique using bacterial blood culture bottles (BCBs) as an alternative. METHODS We performed a retrospective review of patients diagnosed with hip or knee PJI between 1 January 2010 and 31 December 2019, at the Mayo Clinic in Rochester, Minnesota, USA. We included patients aged 18 years or older who had fungal, mycobacterial, or both cultures performed together with bacterial cultures. Cases with positive fungal or mycobacterial cultures were reviewed using the electronic medical record to classify the microbiological findings as representing true infection or not. RESULTS There were 2,067 episodes of PJI diagnosed within the study period. A total of 3,629 fungal cultures and 2,923 mycobacterial cultures were performed, with at least one of these performed in 56% of episodes (n = 1,157). Test positivity rates of fungal and mycobacterial cultures were 5% (n = 179) and 1.2% (n = 34), respectively. After a comprehensive review, there were 40 true fungal and eight true mycobacterial PJIs. BCB were 90% sensitive in diagnosing true fungal PJI and 100% sensitive in detecting rapidly growing mycobacteria (RGM). Fungal stains were performed in 27 true fungal PJI but were only positive in four episodes (14.8% sensitivity). None of the mycobacterial stains was positive. CONCLUSION Routine fungal and mycobacterial stains and cultures should not be performed as they have little clinical utility in the diagnosis of PJI and are associated with significant costs. Candida species and RGM are readily recovered using BCB. More research is needed to predict rare non-Candida fungal and slowly growing mycobacterial PJI that warrant specialized cultures. Cite this article: Bone Joint J 2022;104-B(1):53-58.
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Affiliation(s)
- Don Bambino Geno Tai
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Nancy L Wengenack
- Department of Pathology and Laboratory Medicine, Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Pathology and Laboratory Medicine, Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elie F Berbari
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Tande
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Zhu MF, Kim K, Cavadino A, Coleman B, Munro JT, Young SW. Success Rates of Debridement, Antibiotics, and Implant Retention in 230 Infected Total Knee Arthroplasties: Implications for Classification of Periprosthetic Joint Infection. J Arthroplasty 2021; 36:305-310.e1. [PMID: 32868114 DOI: 10.1016/j.arth.2020.07.081] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/11/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is the most common cause of failure following total knee arthroplasty (TKA). This study aimed to determine the success of debridement, antibiotics, and implant retention (DAIR) in a large cohort of TKA PJIs and assess the utility of current classification systems in predicting DAIR outcomes in early postoperative, late hematogenous, and chronic PJIs. METHODS In a multicenter review over 15 years, 230 patients underwent DAIR for first episode PJI following primary TKA. Patient demographics, disease and surgical factors, treatment regime, and outcomes were identified. Univariate and multivariate survival analyses were performed to identify factors associated with successful DAIR. Continuous variables with predictive value were further analyzed using receiver operating characteristic curves. The ability to predict DAIR outcomes of multiple classification systems was also assessed. RESULTS Patients were followed for an average of 6.9 years. The overall success rate of DAIR was 53.9%. On receiver operating characteristic analysis, 3 months (area under the curve = 0.63) and 1-year age (area under the curve = 0.66) of implant cut-offs was similarly predictive of outcomes. On multivariate survival analysis, DAIR was successful in 64% of "early" PJIs (implant <1 year) vs 38% of "late hematogenous" PJIs (implant >1 year; odds ratio [OR] 1.78, P = .01). For late PJIs (implant >1 year), Staphylococcus aureus (OR 4.70, P < .001) and gram-negative infections (OR 2.56, P = .031) were risk factors for DAIR failure. CONCLUSION DAIR has a high failure rate in all PJIs occurring more than a year post primary TKA, particularly when caused by S aureus or gram-negative bacteria. The age of implant is an important predictor of DAIR outcomes.
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Affiliation(s)
- Mark F Zhu
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Katy Kim
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Alana Cavadino
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Brendan Coleman
- Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Jacob T Munro
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Simon W Young
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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Chisari E, Parvizi J. Accuracy of blood-tests and synovial fluid-tests in the diagnosis of periprosthetic joint infections. Expert Rev Anti Infect Ther 2020; 18:1135-1142. [PMID: 32715785 DOI: 10.1080/14787210.2020.1792771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Periprosthetic joint infection (PJI) is one of the most complex complications following total joint arthroplasty. Despite significant progress in recent years, the use of blood and synovial biomarkers to diagnose PJI remains a challenge. AREAS COVERED A combination of serological, synovial, microbiological, histological, and radiological investigations is suggested by consensus and international guidelines. Novel biomarkers and molecular methods have shown promise in recent years. The purpose of this review is to provide an update about the biomarkers used to diagnose PJI and highlight their sensitivity and specificity. In addition, guidance on the diagnostic steps and clinical workflow will be included. EXPERT OPINION The diagnostic algorithm developed and validated by the international consensus meeting group is still the most valuable resource to approach PJI diagnosis. The current combination of blood and synovial biomarkers yield acceptable results and good performance. However, there is a need for new biomarkers and further research to understand the limitations of current tests better, as well as explore new options such as alpha-defensin, D-dimer, interleukin-6, and leukocyte esterase.
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Affiliation(s)
- Emanuele Chisari
- Rothman Orthopaedic Institute, Thomas Jefferson University , Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute, Thomas Jefferson University , Philadelphia, PA, USA
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Khalid V, Schønheyder HC, Larsen LH, Nielsen PT, Kappel A, Thomsen TR, Aleksyniene R, Lorenzen J, Ørsted I, Simonsen O, Jordal PL, Rasmussen S. Multidisciplinary Diagnostic Algorithm for Evaluation of Patients Presenting with a Prosthetic Problem in the Hip or Knee: A Prospective Study. Diagnostics (Basel) 2020; 10:diagnostics10020098. [PMID: 32053936 PMCID: PMC7168188 DOI: 10.3390/diagnostics10020098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 12/17/2022] Open
Abstract
The predominant indications for revision surgery after total hip (THA) or knee arthroplasty (TKA) are an aseptic failure (AF) and prosthetic joint infection (PJI). Accurate diagnosis is crucial. Therefore, we evaluated prospectively a multidisciplinary diagnostic algorithm including multi-modal radionucleid imaging (RNI) and extended microbiological diagnostics. If the surgeon suspected PJI or AF, revision surgery was performed with multiple samples obtained in parallel for special culture procedures and later molecular analyses. Alternatively, if the underlying cause was not evident, RNI was scheduled comprising 99Tc—HDP SPECT/CT, 111In-labeled white blood cells combined with 99Tc-nanocoll bone marrow SPECT/CT, and 18F-FDG PET/CT. A multidisciplinary clinical team made a recommendation on the indication for a diagnostic procedure guided by RNI images or revision surgery. A total of 156 patients with 163 arthroplasties were included. Fifty-five patients underwent RNI. In all, 118 revision surgeries were performed in 112 patients: 71 on the indication of AF and 41 revision of PJI. Thirty-four patients were concluded with chronic pain, and revision surgery refrained. The effective median follow-up period was 13 months. A structured approach offered by the algorithm was useful for the clinician in the evaluation of patients with a failing TKA or THA. Surgical revision was possibly obviated in approximately 20% of patients where an explanation or cause of failure was not found. The algorithm served as an effective tool.
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Affiliation(s)
- Vesal Khalid
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
- Correspondence: ; Tel.: +45-31336988
| | - Henrik Carl Schønheyder
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Lone Heimann Larsen
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark;
- Center for Microbial Communities, Department of Biotechnology, Chemistry and Environmental Engineering, Aalborg University, 9000 Aalborg, Denmark;
| | - Poul Torben Nielsen
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
| | - Andreas Kappel
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
| | - Trine Rolighed Thomsen
- Center for Microbial Communities, Department of Biotechnology, Chemistry and Environmental Engineering, Aalborg University, 9000 Aalborg, Denmark;
- Danish Technological Institute, Medical Biotechnology, 8000 Aarhus C, Denmark; (J.L.); (P.L.J.)
| | - Ramune Aleksyniene
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Jan Lorenzen
- Danish Technological Institute, Medical Biotechnology, 8000 Aarhus C, Denmark; (J.L.); (P.L.J.)
| | - Iben Ørsted
- Department of Infectious Disease, Aalborg University Hospital, 9000 Aalborg, Denmark;
| | - Ole Simonsen
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
| | - Peter Lüttge Jordal
- Danish Technological Institute, Medical Biotechnology, 8000 Aarhus C, Denmark; (J.L.); (P.L.J.)
| | - Sten Rasmussen
- Orthopaedic Research Unit, Aalborg University Hospital, 9000 Aalborg, Denmark (A.K.); (O.S.); (S.R.)
- Department of Orthopaedic Surgery, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark;
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Goswami K, Parvizi J. Culture-negative periprosthetic joint infection: is there a diagnostic role for next-generation sequencing? Expert Rev Mol Diagn 2019; 20:269-272. [PMID: 31858850 DOI: 10.1080/14737159.2020.1707080] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Karan Goswami
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
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