Department of Bacteriology, Nantes University Hospital, Nantes, France
Inserm, CIC 1415, Tours, France.
J Clin Microbiol. 2018 Aug 27;56(9). doi: 10.1128/JCM.00536-18. Print 2018 Sep.
No gold standard exists for histopathological diagnosis of a prosthetic joint infection (PJI). The historical criterion considers the presence of neutrophil infiltration upon examination of periprosthetic tissue. Morawietz et al. proposed a classification of periprosthetic membranes (Morawietz et al., Clin Pathol 59:591-597, 2006, https://doi.org/10.1136/jcp.2005.027458) and a more recently described classification with a new cutoff value of 23 neutrophils in 10 high-power fields (Morawietz et al., Histopathology 54:847-853, 2009. https://doi.org/10.1111/j.1365-2559.2009.03313.x). We performed a multicenter prospective study, which compared both methods for the diagnosis of PJI. All suspicions of PJI ( = 264) between December 2010 and March 2012 in seven centers were prospectively included. Five perioperative specimens were collected per patient for cultures, and one was collected for histology. Diagnosis of PJI was made according to the Infectious Diseases Society of America (IDSA) guidelines. Histopathological analysis classified the patients according to the threshold of 23 neutrophils and according to the classification of Morawietz. Performances of both methods were compared by using clinical and/or bacteriological criteria as the gold standard. Among 264 patients with suspected PJI, a diagnosis of infection was confirmed in 215 and unconfirmed in 49 patients. Histopathological analysis was available for 150 confirmed PJI and 40 unconfirmed PJI cases. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 78.7%, 90.0%, 96.7%, 52.9%, and 81.1%, respectively, for the Morawietz classification, and 82.0%, 90.0%, 96.9%, 57.1%, and 83.7%, respectively, for the 23-neutrophil threshold. The new algorithm using a threshold of 23 neutrophils can be proposed as a new gold standard for the histopathological diagnosis of PJI.
尚无金标准可用于假体关节感染（PJI）的组织病理学诊断。历史标准认为，在检查假体周围组织时存在中性粒细胞浸润。Morawietz 等人提出了假体周围膜的分类（Morawietz 等人，临床病理学 59:591-597, 2006, https://doi.org/10.1136/jcp.2005.027458）和最近描述的分类，其中 10 个高倍视野中有 23 个中性粒细胞的新截断值（Morawietz 等人，组织病理学 54:847-853, 2009. https://doi.org/10.1111/j.1365-2559.2009.03313.x）。我们进行了一项多中心前瞻性研究，该研究比较了两种用于诊断 PJI 的方法。2010 年 12 月至 2012 年 3 月期间，七个中心共前瞻性纳入了 264 例 PJI 疑似病例。每位患者采集 5 份围手术期标本进行培养，1 份用于组织学检查。PJI 的诊断依据美国传染病学会（IDSA）指南。组织病理学分析根据 23 个中性粒细胞的阈值和 Morawietz 的分类对患者进行分类。使用临床和/或细菌学标准作为金标准比较两种方法的性能。在 264 例疑似 PJI 患者中，215 例确诊感染，49 例未确诊感染。150 例确诊 PJI 和 40 例未确诊 PJI 病例可进行组织病理学分析。Morawietz 分类的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 78.7%、90.0%、96.7%、52.9%和 81.1%，23 个中性粒细胞阈值的分别为 82.0%、90.0%、96.9%、57.1%和 83.7%。使用 23 个中性粒细胞阈值的新算法可作为 PJI 组织病理学诊断的新金标准。
