Romano Carlo Luca, Romanò Delia, Bonora Cristina, Degrate Alessandro, Mineo Giuseppe
Dipartimento di Chirurgia Ricostruttiva e delle Infezioni Osteoarticolari, Statistic and Epidemiology Unit, Istituto Ortopedico I.R.C.C.S. Galeazzi, Milan, Italy.
Infez Med. 2009 Sep;17(3):141-50.
While diagnosing infection of a joint prosthesis often requires a multi-modal approach, evaluation of combined multiple diagnostics is still a rather subjective process. Based on the known sensitivity and specificity of commonly performed tests for joint prosthesis infection, we developed the Combined Diagnostic Tool, a software program that automatically allows the Combined Tests Index (CTI) to be calculated. The CTI indicates, in a given subject, the relative probability of a combined series of positive tests being true compared to negative tests. CTI values above 1 indicate a progressively higher chance of a prosthesis being infected and vice versa. Double-blind, prospective evaluation of CTI, compared to intra-operative cultural and histological findings, was performed in a consecutive cohort of 36 patients. 21 patients had positive intra-operative findings for infection. All of them had a pre-operative CTI >1 (range: 8.8 to 5552.6; mean: 711 +/- 1298). 15 patients had negative intra-operative results. All had a CTI <1 (range: 0.00013 - 0.297; mean 0.074 +/- 0.099). The difference in CTI between the two groups was statistically significant (p = 0.04). Our results show that the Combined Tests Index may be a useful indicator for differential diagnosis of prosthetic infection.
虽然诊断关节假体感染通常需要多模式方法，但对多种诊断方法进行综合评估仍然是一个相当主观的过程。基于关节假体感染常用检测方法已知的敏感性和特异性，我们开发了联合诊断工具，这是一个能自动计算联合检测指数（CTI）的软件程序。CTI在给定个体中表明一系列联合阳性检测结果相对于阴性检测结果为真的相对概率。CTI值大于1表明假体感染的可能性逐渐增加，反之亦然。在连续的36例患者队列中，与术中培养和组织学结果相比，对CTI进行了双盲前瞻性评估。21例患者术中感染结果为阳性。他们所有人术前CTI均>1（范围：8.8至5552.6；平均值：711±1298）。15例患者术中结果为阴性。所有人CTI均<1（范围：0.00013 - 0.297；平均值0.074±0.099）。两组之间CTI的差异具有统计学意义（p = 0.04）。我们的结果表明，联合检测指数可能是假体感染鉴别诊断的有用指标。
