Bémer Pascale, Bourigault Céline, Jolivet-Gougeon Anne, Plouzeau-Jayle Chloé, Lemarie Carole, Chenouard Rachel, Valentin Anne-Sophie, Bourdon Sandra, Leroy Anne-Gaëlle, Corvec Stéphane
Bacteriology Department, CHU Nantes, Nantes Université, Nantes, France.
Bacteriology and Infection Control Department, CHU Nantes, Nantes Université, Nantes, France.
J Bone Jt Infect. 2020 Mar 30;5(2):89-95. doi: 10.7150/jbji.42076. eCollection 2020.
The diagnosis of prosthetic joint infections (PJIs) can be difficult in the chronic stage and is based on clinical and paraclinical evidence. A minimally invasive serological test against the main pathogens encountered during PJI would distinguish PJI from mechanical loosening. We performed a prospective, multicentre, cross-sectional study to assess the contribution of serology in the diagnosis of PJI. Over a 2-year period, all patients undergoing prosthesis revision were included in the study. A C-reactive protein assay and a serological test specifically designed against 5 bacterial species (, , , ) were performed preoperatively. Five samples per patient were taken intraoperatively during surgery. The diagnosis of PJI was based on clinical and bacteriological criteria according to guidelines. Between November 2015 and November 2017, 115 patients were included, 49 for a chronic PJI and 66 for a mechanical problem. Among patients with PJI, a sinus tract was observed in 32.6% and a C-reactive protein level ≥10 mg/L in 74.5%. The PJI was monomicrobial in 43 cases (targeted staphylococci, 24; , 1; , 2; others, 16), and polymicrobial in 6 cases (12.2%). Sensitivity, specificity, positive predictive value and negative predictive value were 75.0%, 82.1%, 58.3% and 90.8%, respectively, for targeted staphylococci. Specificity/negative predictive value was 97.3%/100% for and 83.8% /96.9% for . The serological tests are insufficient to affirm the diagnosis of PJI for the targeted bacteria. Nevertheless, the excellent NPV may help clinicians to exclude PJI.
人工关节感染（PJI）在慢性期的诊断可能具有挑战性，且诊断基于临床和辅助临床证据。针对PJI期间遇到的主要病原体进行的微创血清学检测将有助于区分PJI与机械性松动。我们进行了一项前瞻性、多中心横断面研究，以评估血清学在PJI诊断中的作用。在两年时间里，所有接受假体翻修的患者均纳入研究。术前进行了C反应蛋白检测以及专门针对5种细菌（、、、）设计的血清学检测。手术中为每位患者采集了5份样本。PJI的诊断根据指南基于临床和细菌学标准。2015年11月至2017年11月期间，共纳入115例患者，其中49例为慢性PJI，66例存在机械性问题。在PJI患者中，32.6%观察到有窦道，74.5%的患者C反应蛋白水平≥10 mg/L。43例PJI为单一微生物感染（目标葡萄球菌24例；、1例；、2例；其他16例），6例为多微生物感染（12.2%）。针对目标葡萄球菌，敏感性、特异性、阳性预测值和阴性预测值分别为75.0%、82.1%、58.3%和90.8%。针对和的特异性/阴性预测值分别为97.3%/100%和83.8%/96.9%。血清学检测不足以确诊目标细菌引起的PJI。然而，出色的阴性预测值可能有助于临床医生排除PJI。
