Röhrl Alexander, Klawonn Frank, Füchtmeier Bernd, Wulbrand Christian, Gessner Andre, Zustin Jozef, Ambrosch Andreas
Department of Trauma Surgery, Orthopaedics & Sports Medicine, Hospital of Brothers of Mercy, Regensburg, Germany.
Biostatistics, Helmholtz Centre for Infection Research, Brunswick, Germany.
Infection. 2024 Dec;52(6):2287-2296. doi: 10.1007/s15010-024-02278-x. Epub 2024 May 10.
To confirm the diagnosis of periprosthetic joint infection (PJI), the Infectious Diseases Society of America (IDSA) and the International Consensus Meeting (ICM) have defined criteria that include histology as a minor criterion and the sonication method only as an additional criterion. The aim of this monocentric, retrospective study was to investigate the value of histology and whether sonication leads to a more accurate diagnosis.
All revision surgeries for knee and hip arthroplasty between 2017 and 2020 were included. With regard to microbiological diagnostic, conventional culture of periprosthetic biopsies and sonication of explant material were performed. In addition, histology and non-specific inflammatory markers (CRP, leukocytes) were recorded.
A total of 78 patients with PJI and 62 aseptic controls were included. From both microbiological methods (conventional culture / sonication), Staphyloccus (S.) epidermidis and S. aureus were detected most frequently. However, compared to the conventional microbiology, a higher sensitivity was calculated for sonication, albeit with a lower specificity in relation to a PJI. In two logistic regression models for the significance of all diagnostic parameters in PJI, the AUC was 0.92 and 0.96 with histology in particular making the decisive contribution in both models (p < 0. 001, both models).
Since histology showed the highest accuracy in the current study, its importance in the PJI criteria should be reevaluated. Sonication shows a high sensitivity for germ detection with a lower specificity and should only be used in combination with the conventional culture for microbiolgical diagnostics.
为确诊人工关节周围感染（PJI），美国传染病学会（IDSA）和国际共识会议（ICM）制定了相关标准，其中组织学为次要标准，超声处理方法仅作为附加标准。本单中心回顾性研究的目的是调查组织学的价值以及超声处理是否能带来更准确的诊断。
纳入2017年至2020年间所有膝关节和髋关节置换翻修手术病例。在微生物诊断方面，对人工关节周围组织活检进行常规培养，并对外植体材料进行超声处理。此外，记录组织学和非特异性炎症标志物（CRP、白细胞）情况。
共纳入78例PJI患者和62例无菌对照。在两种微生物学方法（常规培养/超声处理）中，最常检测到的是表皮葡萄球菌和金黄色葡萄球菌。然而，与传统微生物学相比，超声处理的敏感性更高，尽管其对PJI的特异性较低。在两个关于PJI所有诊断参数意义的逻辑回归模型中，曲线下面积（AUC）分别为0.92和0.96，组织学在两个模型中均起决定性作用（p < 0.001，两个模型）。
由于在本研究中组织学显示出最高的准确性，应重新评估其在PJI标准中的重要性。超声处理对病原体检测具有高敏感性，但特异性较低，仅应与常规培养联合用于微生物诊断。
