Yoshida Atsuhiro, Akazawa Tsutomu, Torii Yoshiaki, Ueno Jun, Iinuma Masahiro, Niki Hisateru
Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Spine Center, St. Marianna University Hospital, Kawasaki, Japan.
Spine Surg Relat Res. 2022 Apr 12;6(5):443-447. doi: 10.22603/ssrr.2022-0006. eCollection 2022 Sep 27.
The alpha-defensin lateral flow test has been used in periprosthetic joint infection as a diagnostic support tool because of its simplicity and speed. However, the test has not been used to diagnose spinal infections. The purpose of this study was to investigate the efficacy of the alpha-defensin lateral flow test for diagnosing spinal infections.
The subjects were 11 patients who were suspected of having spinal infections from October 2019 to August 2021 and underwent biopsies at a single institution. There were nine male and two female patients, with an average age of 60.7 (14-87) years. For diagnosing infection, the patient's consent for biopsy was obtained, and the sample was collected by computed tomography-guided aspiration biopsy or open biopsy at the site considered to be a possible abscess. The samples were subjected to a bacterial culture test, an acid-fast bacillus culture test, and an alpha-defensin lateral flow test (Synovasure lateral flow test; Zimmer Biomet, IN, USA).
Of the 11 suspected spinal infections, the alpha-defensin lateral flow test was positive in 8 cases, negative in 2 cases, and undeterminable in 1 case. Of the 10 cases excluding the undeterminable case, the definitive diagnosis was 9 cases of spinal infection (spondylitis: 6 cases, spinal implant infection: 3 cases) and 1 case of vertebral body fracture. The alpha-defensin lateral flow test demonstrated a sensitivity of 88.9%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 50%. The biopsy sample culture test demonstrated a sensitivity of 77.8%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 33.3%.
We suggested that the alpha-defensin lateral flow test might be useful as a diagnostic support tool for spinal infections.
α-防御素侧向流动检测因其简便性和快速性，已被用作假体周围关节感染的诊断辅助工具。然而，该检测尚未用于诊断脊柱感染。本研究的目的是探讨α-防御素侧向流动检测在诊断脊柱感染中的有效性。
研究对象为2019年10月至2021年8月期间在一家机构疑似患有脊柱感染并接受活检的11例患者。其中男性9例，女性2例，平均年龄60.7（14 - 87）岁。为诊断感染，获得患者的活检同意书，并通过计算机断层扫描引导下的穿刺活检或在被认为可能存在脓肿的部位进行开放活检采集样本。样本进行细菌培养检测、抗酸杆菌培养检测和α-防御素侧向流动检测（Synovasure侧向流动检测；美国印第安纳州捷迈邦美公司）。
在11例疑似脊柱感染病例中，α-防御素侧向流动检测8例呈阳性，2例呈阴性，1例结果无法确定。在排除结果无法确定的病例后的10例中，最终诊断为9例脊柱感染（脊柱炎：6例，脊柱植入物感染：3例）和1例椎体骨折。α-防御素侧向流动检测的灵敏度为88.9%，特异度为100%，阳性预测值为100%，阴性预测值为50%。活检样本培养检测的灵敏度为77.8%，特异度为100%，阳性预测值为100%，阴性预测值为33.3%。
我们认为α-防御素侧向流动检测可能作为脊柱感染的诊断辅助工具有用。
