Drago Lorenzo, Toscano Marco, Tacchini Lorenza, Banfi Giuseppe
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Clin Chem Lab Med. 2017 Nov 27;56(1):19-24. doi: 10.1515/cclm-2017-0041.
Periprosthetic joint infection (PJI) is a serious complication that may occur after native joint replacement leading to a severe health and economic burden. Currently, due to several confounding factors, PJI is difficult to diagnose. Today, a multidisciplinary approach is indispensable to correctly define a periprosthetic joint infection; indeed, tissue histology, microbiology cultures and clinical findings are used together to achieve this goal. Analysis of α-defensin is commonly used for PJI diagnosis, as it allows the rapid detection of α-defensin present in the synovial fluid following a microbial infection. Currently, a point-of-care testing (POCT) assay able to detect the presence of human α-defensins 1-3 in synovial fluid of patients is aimed directly at orthopedic surgeons. However, many orthopedic surgeons lack experience and training in quality laboratory practices, often failing to appreciate the significance of quality control and proper documentation when using POCT assays. To guarantee the highest quality diagnostic services, the α-defensin test should be used together with other biochemical and microbiological criteria commonly used for PJI diagnosis. Additionally, the close cooperation and communication between laboratory, pathologists and physicians is of fundamental importance in the correct diagnosis of PJI.
人工关节周围感染（PJI）是一种严重的并发症，可能发生在初次关节置换术后，导致严重的健康和经济负担。目前，由于多种混杂因素，PJI难以诊断。如今，多学科方法对于正确定义人工关节周围感染不可或缺；实际上，组织组织学、微生物培养和临床发现共同用于实现这一目标。α-防御素分析常用于PJI诊断，因为它能够快速检测微生物感染后滑液中存在的α-防御素。目前，一种能够检测患者滑液中人类α-防御素1-3的即时检测（POCT）分析方法直接面向骨科医生。然而，许多骨科医生缺乏质量实验室操作方面的经验和培训，在使用POCT分析方法时常常未能认识到质量控制和正确记录的重要性。为了保证最高质量的诊断服务，α-防御素检测应与其他常用于PJI诊断的生化和微生物学标准一起使用。此外，实验室、病理学家和医生之间的密切合作与沟通对于PJI的正确诊断至关重要。
