Stylianakis Antonios, Schinas Georgios, Thomaidis Pavlos C, Papaparaskevas Joseph, Ziogas Dimitrios C, Gamaletsou Maria N, Daikos George L, Pneumaticos Spyros, Sipsas Nikolaos V
Laboratory of Implant Associated Infections, Department of Microbiology, "KAT" General Hospital, Athens, Greece.
3(rd) Department of Orthopaedic Surgery, "KAT" General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Diagn Microbiol Infect Dis. 2018 Sep;92(1):13-18. doi: 10.1016/j.diagmicrobio.2018.04.008. Epub 2018 Apr 21.
We assessed the value of conventional culture, vial culture, and broad-range PCR of the sonication fluid (SF), individually or in combinations, for the diagnosis of prosthetic joint infection (PJI). We studied 114 consecutive patients (median age:72.5 years, males: 28.07%) undergoing removal of a total knee or hip prosthesis. By non-microbiologic criteria, 87 patients had aseptic failure, and 27 PJI. All patients had periprosthetic tissue culture, sonication of prosthesis, and study of SF by conventional and vial culture, and PCR. Compared to tissue culture, each test was significantly more sensitive and less specific. If only one test was positive, the sensitivity was 88.46% and specificity 64.29%. If all three SF tests were positive, sensitivity, and NPV were decreasing (34.6% and 80.23%), but specificity and PPV were increasing up to 98.57% and 90.9%, respectively, outperforming tissue culture. A triple negative test practically excluded PJI.
我们评估了超声处理液（SF）的传统培养、瓶培养和广谱聚合酶链反应（PCR）单独或联合用于诊断人工关节感染（PJI）的价值。我们研究了114例连续接受全膝关节或髋关节假体移除术的患者（中位年龄：72.5岁，男性：28.07%）。根据非微生物学标准，87例患者为无菌性失败，27例为PJI。所有患者均进行了假体周围组织培养、假体超声处理以及通过传统培养、瓶培养和PCR对SF进行检测。与组织培养相比，每项检测的敏感性显著更高，特异性更低。如果只有一项检测呈阳性，敏感性为88.46%，特异性为64.29%。如果三项SF检测均呈阳性，敏感性和阴性预测值会降低（分别为34.6%和80.23%），但特异性和阳性预测值分别增至98.57%和90.9%，优于组织培养。三项检测均为阴性实际上可排除PJI。
