Enz Andreas, Becker Johanna, Warnke Philipp, Prall Friedrich, Lutter Christoph, Mittelmeier Wolfram, Klinder Annett
Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Straße 142, 18057 Rostock, Germany.
Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsmedizin Rostock, Schillingallee 70, 18057 Rostock, Germany.
J Clin Med. 2020 Oct 20;9(10):3364. doi: 10.3390/jcm9103364.
The diagnosis of low-grade infections of endoprostheses is challenging. There are still no unified guidelines for standardised diagnostic approaches, recommendations are categorised into major and minor criteria. Additional histopathological samples might sustain the diagnosis. However, ambulatory preoperative biopsy collection is not widespread.
102 patients with hip or knee endoprosthesis and suspected periprosthetic joint infection (PJI) were examined by arthrocentesis with microbiological sample and histopathological punch biopsy. The data were retrospectively analysed for diagnosis concordance.
Preoperative microbiology compared to intraoperative results was positive in 51.9% (sensitivity 51.9%, specificity 97.3%). In comparison of preoperative biopsy to intraoperative diagnostic results 51.9% cases were positive (sensitivity 51.9%, specificity 100.0%). The combination of preoperative biopsy and microbiology in comparison to intraoperative results was positive in 70.4% of the cases (sensitivity 70.4%, specificity 97.3%).
The diagnosis of PJI is complex. One single method to reliably detect an infection is currently not available. With the present method histopathological samples might be obtained quickly, easily and safely for the preoperative detection of PJI. A combination of microbiological and histopathological sampling increases the sensitivity up to 18.5% to detect periprosthetic infection.
人工关节假体低度感染的诊断具有挑战性。目前仍没有关于标准化诊断方法的统一指南，相关建议分为主要标准和次要标准。额外的组织病理学样本可能有助于确诊。然而，术前门诊活检采集并不普遍。
对102例髋关节或膝关节假体且疑似假体周围关节感染（PJI）的患者进行关节穿刺术，采集微生物样本和组织病理学穿刺活检样本。对数据进行回顾性分析以评估诊断一致性。
术前微生物学检查结果与术中结果相比，阳性率为51.9%（敏感性51.9%，特异性97.3%）。术前活检结果与术中诊断结果相比，51.9%的病例为阳性（敏感性51.9%，特异性100.0%）。术前活检和微生物学检查结果与术中结果相结合，70.4%的病例为阳性（敏感性70.4%，特异性97.3%）。
PJI的诊断较为复杂。目前尚无一种能可靠检测感染的单一方法。采用本方法可快速、简便且安全地获取组织病理学样本用于术前PJI检测。微生物学和组织病理学采样相结合可将检测假体周围感染的敏感性提高18.5%。
