术前抽吸物与术中关节液培养结果的一致性：无论术前抽吸培养结果如何，术中都有必要进行关节液再培养。
The concordance between preoperative aspiration and intraoperative synovial fluid culture results: intraoperative synovial fluid re-cultures are necessary whether the preoperative aspiration culture is positive or not.
机构信息
Medical School of Chinese PLA, Beijing, People's Republic of China.
Department of Orthopedic Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing road, Beijing, People's Republic of China.
出版信息
BMC Infect Dis. 2021 Sep 29;21(1):1018. doi: 10.1186/s12879-021-06721-4.
AIMS
Preoperative aspiration culture and intraoperative cultures play pivotal roles in periprosthetic joint infection (PJI) diagnosis and pathogen identification. But the discordance between preoperative aspiration culture and intraoperative synovial fluid culture remains unknown. We aim to determine (1) the discordance between preoperative and intraoperative synovial fluid (SF) culture and. (2) compared to intraoperative synovial fluid cultures, the sensitivity of preoperative aspiration fluid culture. Then the following question is tried to be answered: Are intraoperative synovial fluid re-cultures necessary if the preoperative aspiration culture is positive?
MATERIALS AND METHODS
Between 2015 and 2019, 187 PJI patients managed with surgeries were included in this study. Compared to intraoperative synovial fluid culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative aspiration culture were calculated. Then, the discordance between preoperative aspiration culture and intraoperative SF culture was analyzed.
RESULTS
The sensitivity of preoperative aspiration culture was 81.29% compared to intraoperative synovial fluid cultures. Concordance was identified in 147 PJI (78.61%) patients and culture discordance occurred in 40 patients (21.39%). In these discordant PJI patients, 24 patients (60%) were polymicrobial and no intraoperative synovial fluid culture growth was found in 16 PJI cases (40%). Preoperative monomicrobial staphylococcus results had a sensitivity of and a specificity of 80.43% and 83.16%, respectively. Preoperative polymicrobial results had the lowest sensitivity.
CONCLUSIONS
The intraoperative synovial fluid re-cultures are necessary if the preoperative aspiration culture is positive and the discordance between preoperative aspiration culture and intraoperative synovial fluid culture should be noted especially when Streptococcus spp. and more than one pathogen was revealed by preoperative aspiration culture.
LEVEL OF EVIDENCE
Level III.
目的
术前抽吸培养和术中培养在假体周围关节感染（PJI）的诊断和病原体鉴定中起着关键作用。但术前抽吸培养与术中滑膜液培养之间的不一致性尚不清楚。我们旨在确定：（1）术前与术中滑膜液（SF）培养之间的差异；（2）与术中滑膜液培养相比，术前抽吸液培养的敏感性。然后试图回答以下问题：如果术前抽吸培养阳性，是否需要进行术中滑膜液再培养？
材料和方法
2015 年至 2019 年期间，共纳入 187 例接受手术治疗的 PJI 患者进行本研究。与术中滑膜液培养相比，计算了术前抽吸培养的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。然后，分析了术前抽吸培养与术中 SF 培养之间的差异。
结果
与术中滑膜液培养相比，术前抽吸培养的敏感性为 81.29%。在 147 例 PJI（78.61%）患者中发现了一致性，而在 40 例患者（21.39%）中出现了培养不一致。在这些培养不一致的 PJI 患者中，24 例（60%）为多微生物，16 例 PJI 患者（40%）术中未发现滑膜液培养生长。术前单微生物金黄色葡萄球菌的敏感性和特异性分别为 80.43%和 83.16%。术前多微生物结果的敏感性最低。
结论
如果术前抽吸培养阳性，术中需要进行滑膜液再培养，术前抽吸培养与术中滑膜液培养之间的差异应引起注意，特别是当术前抽吸培养显示链球菌属和一种以上病原体时。
证据水平
III 级。
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