Bozhkova Svetlana, Suardi Virginia, Sharma Hemant K, Tsuchiya Hiroyuki, Del Sel Hernán, Hafez Mahmoud A, Benzakour Thami, Drago Lorenzo, Romanò Carlo Luca
R.R. Vreden Russian Research Institute of Traumatology and Orthopaedics, S. Petersburg 195427, Russia.
RNIITO Department of Prevention and Treatment of Wound Infection, S. Petersburg 195427, Russia.
J Clin Med. 2020 Jun 23;9(6):1965. doi: 10.3390/jcm9061965.
Peri-prosthetic joint infection (PJI) definition plays an important role in diagnostic and therapeutic decisions. However, while several criteria have been proposed by eminent institutions to define a PJI in the last decade, their clinical validation has been rarely performed. Aim of the present multicenter, international, retrospective study was to validate the World Association against Infection in Orthopedics and Trauma (WAIOT) pre/intra-operative PJI definition with post-operative confirmatory tests. A total of 210 patients, undergoing hip ( = 86) or knee ( = 124) revision surgery for any reason in six orthopedic centers in Africa, Asia, Europe and South America, were retrospectively evaluated at a two years minimum follow-up after surgery. All the available pre-, intra- and post-operative findings were collected and analyzed according to the WAIOT criteria, which include a set of tests to confirm (Rule In) or to exclude (Rule Out) a PJI. On average, patients were investigated pre/intra-operatively with 3.1 ± 1.1 rule out and 2.7 ± 0.9 rule in tests; the presence of a fistula or exposed implant was reported in 37 patients (17.6%). According to pre/intraoperative findings, 36.2% of the patients were defined as affected by high-grade PJI ( = 76; average score: 2.3 ± 0.8), 21.9% by low-grade PJI ( = 46; average score: 0.8 ± 0.8), 10.5% by biofilm-related implant malfunction ( = 22; average score: -1.6 ± 0.8), 2.9% as contamination ( = 6; average score: -3.5 ± 1.0), and 28.6% as no infection ( = 60; average score: -3.0 ± 1.4). Pre/intra-operative PJI definitions matched post-operative confirmatory tests, in 97.1% of the patients. This is, to our knowledge, one of the largest study ever conducted to validate a PJI definition The retrospective analysis in different centers was greatly facilitated by the structure of the WAIOT definition, that allows to include different tests on the basis of their sensitivity/specificity, while the comparison between pre/intra-operative and post-operative findings offered the internal validation of the scoring system. Our results authenticate the WAIOT definition as a reliable, simple tool to identify patients affected by PJI prior to joint revision surgery.
人工关节周围感染（PJI）的定义在诊断和治疗决策中起着重要作用。然而，尽管在过去十年中一些知名机构提出了几种定义PJI的标准，但它们的临床验证却很少进行。本多中心、国际性、回顾性研究的目的是通过术后确证试验来验证世界骨科与创伤感染防治协会（WAIOT）术前/术中PJI的定义。在非洲、亚洲、欧洲和南美洲的六个骨科中心，共有210例因任何原因接受髋关节（n = 86）或膝关节（n = 124）翻修手术的患者在术后至少随访两年后进行回顾性评估。根据WAIOT标准收集并分析所有可用的术前、术中和术后检查结果，该标准包括一组用于确证（纳入标准）或排除（排除标准）PJI的检查。平均而言，患者在术前/术中接受了3.1 ± 1.1项排除检查和2.7 ± 0.9项纳入检查；37例患者（17.6%）报告存在瘘管或植入物外露。根据术前/术中检查结果，36.2%的患者被定义为患有高度PJI（n = 76；平均评分：2.3 ± 0.8），21.9%为低度PJI（n = 46；平均评分：0.8 ± 0.8），10.5%为生物膜相关植入物功能障碍（n = 22；平均评分：-1.6 ± 0.8），2.9%为污染（n = 6；平均评分：-3.5 ± 1.0），28.6%为无感染（n = 60；平均评分：-3.0 ± 1.4）。术前/术中PJI定义与术后确证试验在97.1%的患者中相符。据我们所知，这是有史以来为验证PJI定义而进行的最大规模研究之一。WAIOT定义的结构极大地促进了不同中心的回顾性分析，该结构允许根据检查的敏感性/特异性纳入不同的检查，而术前/术中与术后检查结果的比较为评分系统提供了内部验证。我们的结果证实WAIOT定义是一种可靠、简单的工具，可用于在关节翻修手术前识别受PJI影响的患者。
