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当前用于检测人工关节周围感染的临床方法。

Current Clinical Methods for Detection of Peri-Prosthetic Joint Infection.

机构信息

Warren Alpert Medical School of Brown University, Brown University, Providence, Rhode Island, USA.

Brown University, Providence, Rhode Island, USA.

出版信息

Surg Infect (Larchmt). 2020 Oct;21(8):645-653. doi: 10.1089/sur.2019.314. Epub 2020 Feb 11.

Abstract

Currently, one of the most pressing problems in the field of orthopedic surgery is peri-prosthetic joint infection [PJI]. While there are numerous ways to detect PJI, current clinical detection methods differ across institutions and have varying criteria and protocols. Some of these methods include the Modified Musculoskeletal Infection Society system, culturing, polymerase chain reaction, the determination of the presence of certain biomarkers, testing for the presence of alpha defensin peptides, and leukocyte level testing. This review summarizes the most recent publications in the field of PJI detection to highlight current strengths as well as provide future directions to find the system for the quickest, cost-effective, and most accurate way to diagnose these types of infections. The results of this literature review suggest that, while each method of diagnosis has its advantages, each has various drawbacks as well. Current methods can be expensive, take days to weeks to complete, be prone to contamination, and can produce ambiguous results. The findings in this review emphasize the need for a more comprehensive and accurate system for diagnosing PJI. In addition, the specific comparison of advantages and drawbacks can be useful for researchers and clinicians with goals of creating new diagnostic tests for PJIs, as well as in clinical scenarios to determine the correct treatment for patients.

摘要

目前,矫形外科领域最紧迫的问题之一是人工关节周围感染[PJI]。虽然有许多方法可以检测 PJI,但目前的临床检测方法在不同的机构之间存在差异,并且有不同的标准和方案。这些方法包括改良肌肉骨骼感染协会系统、培养、聚合酶链反应、确定某些生物标志物的存在、检测α防御素肽的存在以及白细胞水平检测。 本综述总结了 PJI 检测领域的最新出版物,以突出当前的优势,并为寻找最快、最具成本效益和最准确的方法来诊断这些类型的感染提供未来的方向。 文献综述的结果表明,虽然每种诊断方法都有其优点,但每种方法也都有其各自的缺点。目前的方法可能很昂贵,需要数天到数周的时间才能完成,容易受到污染,并且可能产生模棱两可的结果。 本综述的研究结果强调了需要建立一个更全面和准确的系统来诊断 PJI。此外,对优缺点的具体比较对于希望为 PJI 开发新诊断测试的研究人员和临床医生以及在临床情况下为患者确定正确的治疗方法都非常有用。

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What Is the Diagnostic Accuracy of Alpha-Defensin and Leukocyte Esterase Test in Periprosthetic Shoulder Infection?
Clin Orthop Relat Res. 2019 Jul;477(7):1712-1718. doi: 10.1097/CORR.0000000000000762.

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