Porto Bone and Joint Infection Group (GRIP), Department of Orthopedics, Centro Hospitalar Universitário do Porto and CUF - Hospitais e Clínicas, Portugal.
Department of Orthopedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Acta Orthop. 2023 Jan 23;94:8-18. doi: 10.2340/17453674.2023.5670.
A new periprosthetic joint infection (PJI) definition has recently been proposed by the European Bone and Joint Infection Society (EBJIS). The goals of this paper are to evaluate its diagnostic accuracy and compare it with previous definitions and to assess its accuracy in preoperative diagnosis.
We retrospectively evaluated a multicenter cohort of consecutive revision total hip and knee arthroplasties. Cases with minimum required diagnostic workup were classified according to EBJIS, 2018 International Consensus Meeting (ICM 2018), Infectious Diseases Society of America (IDSA), and modified 2013 Musculoskeletal Infection Society (MSIS) definitions. 2 years' minimum follow-up was required to assess clinical outcome.
Of the 472 cases included, PJI was diagnosed in 195 (41%) cases using EBJIS; 188 (40%) cases using IDSA; 172 (36%) using ICM 2018; and 145 (31%) cases using MSIS. EBJIS defined fewer cases as intermediate (5% vs. 9%; p = 0.01) compared with ICM 2018. Specificity was determined by comparing risk of subsequent PJI after revision surgery. Infected cases were associated with higher risk of subsequent PJI in every definition. Cases classified as likely/confirmed infections using EBJIS among those classified as not infected in other definitions showed a significantly higher risk of subsequent PJI compared with concordant non-infected cases using MSIS (RR = 3, 95% CI 1-6), but not using ICM 2018 (RR = 2, CI 1-6) or IDSA (RR = 2, CI 1-5). EBJIS showed the highest agreement between pre-operative and definitive classification (k = 0.9, CI 0.8-0.9) and was better at ruling out PJI with an infection unlikely result (sensitivity 89% [84-93], negative predictive value 90% [85-93]).
The newly proposed EBJIS definition emerged as the most sensitive of all major definitions. Cases classified as PJI according to the EBJIS criteria and not by other definitions seem to have increased risk of subsequent PJI compared with concordant non-infected cases. EBJIS classification is accurate in ruling out infection preoperatively.
欧洲骨与关节感染学会（EBJIS）最近提出了一种新的假体周围关节感染（PJI）定义。本文的目的是评估其诊断准确性，并与之前的定义进行比较，以及评估其在术前诊断中的准确性。
我们回顾性评估了一个多中心连续的翻修全髋关节和膝关节置换术队列。根据 EBJIS、2018 年国际共识会议（ICM 2018）、美国感染病学会（IDSA）和改良 2013 年肌肉骨骼感染学会（MSIS）定义，对具有最低必需诊断检查的病例进行分类。需要至少 2 年的随访来评估临床结果。
在纳入的 472 例病例中，EBJIS 诊断为 195 例（41%）PJI；188 例（40%）使用 IDSA；172 例（36%）使用 ICM 2018；145 例（31%）使用 MSIS。与 ICM 2018 相比，EBJIS 将更少的病例定义为中间型（5%比 9%；p=0.01）。通过比较翻修手术后发生后续 PJI 的风险来确定特异性。在每种定义中，感染病例与后续发生 PJI 的风险更高相关。在其他定义中被归类为未感染的病例中，使用 EBJIS 归类为可能/确诊感染的病例与使用 MSIS 归类为一致的非感染病例相比，发生后续 PJI 的风险显著更高（RR=3，95%CI 1-6），但与 ICM 2018（RR=2，95%CI 1-6）或 IDSA（RR=2，95%CI 1-5）不一致。EBJIS 在术前和最终分类之间具有最高的一致性（k=0.9，95%CI 0.8-0.9），并且在排除感染可能性不大的情况下效果更好（敏感性 89%[84-93]，阴性预测值 90%[85-93]）。
新提出的 EBJIS 定义是所有主要定义中最敏感的。根据 EBJIS 标准分类为 PJI 但不符合其他标准的病例与符合标准的非感染病例相比，似乎具有更高的后续 PJI 风险。EBJIS 分类在术前准确排除感染。
