1
|
Dey M, Al-Attar M, Peruffo L, Coope A, Zhao SS, Duffield S, Goodson N. Assessment and diagnosis of the acute hot joint: a systematic review and meta-analysis. Rheumatology (Oxford) 2023; 62:1740-1756. [PMID: 36264140 PMCID: PMC10152293 DOI: 10.1093/rheumatology/keac606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/30/2022] [Accepted: 10/15/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Prompt diagnosis of septic arthritis (SA) in acute native hot joints is essential for avoiding unnecessary antibiotics and hospital admissions. We evaluated the utility of synovial fluid (SF) and serum tests in differentiating causes of acute hot joints. METHODS We performed a systematic literature review of diagnostic testing for acute hot joints. Articles were included if studying ≥1 serum or SF test(s) for an acute hot joint, compared with clinical assessment and SF microscopy and culture. English-language articles only were included, without date restriction. The following were recorded for each test, threshold and diagnosis: sensitivity, specificity, positive/negative predictive values and likelihood ratios. For directly comparable tests (i.e. identical fluid, test and threshold), bivariate random-effects meta-analysis was used to pool sensitivity, specificity, and areas under the curves. RESULTS A total of 8443 articles were identified, and 49 were ultimately included. Information on 28 distinct markers in SF and serum, differentiating septic from non-septic joints, was extracted. Most had been tested at multiple diagnostic thresholds, yielding a total of 27 serum markers and 156 SF markers. Due to heterogeneity of study design, outcomes and thresholds, meta-analysis was possible for only eight SF tests, all differentiating septic from non-septic joints. Of these, leucocyte esterase had the highest pooled sensitivity [0.94 (0.70, 0.99)] with good pooled specificity [0.74 (0.67, 0.81)]. CONCLUSION Our review demonstrates many single tests, individually with diagnostic utility but suboptimal accuracy for exclusion of native joint infection. A combination of several tests with or without a stratification score is required for optimizing rapid assessment of the hot joint.
Collapse
Affiliation(s)
- Mrinalini Dey
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Rheumatology, Queen Elizabeth Hospital, London, UK
| | | | - Leticia Peruffo
- School of Medicine, Federal University of Parana, Curitiba, Brazil
| | - Ashley Coope
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sizheng Steven Zhao
- Versus Arthritis Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Stephen Duffield
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Nicola Goodson
- Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
2
|
Haertlé M, Kolbeck L, Macke C, Graulich T, Stauß R, Omar M. Diagnostic Accuracy for Periprosthetic Joint Infection Does Not Improve by a Combined Use of Glucose and Leukocyte Esterase Strip Reading as Diagnostic Parameters. J Clin Med 2022; 11:jcm11112979. [PMID: 35683369 PMCID: PMC9181009 DOI: 10.3390/jcm11112979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/11/2022] [Accepted: 05/19/2022] [Indexed: 11/26/2022] Open
Abstract
The diagnosis of periprosthetic infections (PJI) can be challenging in clinical practice because the clinical presentations of aseptic loosening and low-grade infections are similar. Semiquantitative evaluation of leukocyte esterase (LE) in synovial fluid using a urine strip test has already established itself as a diagnostic method over the past decade. The analysis of LE in synovial fluid leads to a high number of false-positive test results. In the present study, the value of a combined semiquantitative determination of glucose and LE in synovial fluid to improve the diagnosis of PJI was investigated. Over a 4-year period, 145 synovial samples were collected from patients who developed joint effusion after arthroplasty. LE and glucose test strips were considered as an index test for the diagnosis of PJI. A ++ or +++ LE and a negative glucose test strip reading were considered as positive test results. Modified diagnostic criteria for PJI as recommended by the Musculoskeletal Infection Society (MSIS) served as the reference test, except that intraoperative findings were excluded. Forty-six out of 145 samples were classified as septic complication according to the reference test. In regard to PJI, our data showed that combined use of LE and glucose strip test reading displayed a 98.0% specificity (95% confidence interval (CI): 95.2% to 100%), a 50% sensitivity (95% CI: 35.6% to 64.4%), a 92% positive predictive value (95% CI: 81.4% to 100.0%), and an 80.3% negative predictive value (95% CI: 73.2% to 87.4%). In contrast, the exclusive analysis of LE on the urine strip to diagnose PJI demonstrated a 90.9% specificity (95% CI: 85.2% to 96.6%), a 67.4% sensitivity (95% CI: 53.8% to 80.9%), a 77.5% positive predictive value (95% CI: 64.6% to 90.4%), and an 85.7% negative predictive value (5% CI: 79.0% to 92.4%). A combination of LE and glucose test pad reading is considered superior as a potential “rule-in” method for the diagnosis of PJI compared with LE test pad analysis alone. However, combined LE and glucose synovial fluid testing also demonstrated lower test sensitivity and thus diagnostic accuracy compared with LE analysis alone. Therefore, combined glucose and LE test pad analysis does not represent a sufficient diagnostic standard to exclude PJI with certainty.
Collapse
|
3
|
Kolbeck L, Haertlé M, Graulich T, Ettinger M, Suero EM, Krettek C, Omar M. Leukocyte Esterase and Glucose Reagent Test Can Rule in and Rule out Septic Arthritis. In Vivo 2021; 35:1625-1632. [PMID: 33910845 DOI: 10.21873/invivo.12420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/11/2021] [Accepted: 02/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Septic arthritis (SA) requires rapid diagnosis and therapy to avoid joint damage. This study evaluated the diagnostic accuracy of leukocyte esterase (LE) and glucose (GLC) strip tests for diagnosing SA. PATIENTS AND METHODS Synovial fluids from 455 patients with atraumatic joint effusions were assessed prospectively over a 5-year period with LE and glucose strip tests. Results were compared to modified Newman criteria for diagnosing joint infections. Synovial fluid cultures, crystal, blood and synovial cell analyses were also performed. RESULTS Forty-one patients had SA and 252 non-SA. A positive LE reading combined with negative glucose reading could detect SA with 100% specificity, 85% sensitivity, 100% positive predictive value (PPV) and 98% negative predictive value (NPV). Positive synovial LE reading alone detected SA with 82% specificity, 95% sensitivity, 47% PPV, and 99% NPV. CONCLUSION Combined LE and glucose strip tests represent a low-cost tool for rapidly diagnosing or ruling out SA.
Collapse
Affiliation(s)
- Louisa Kolbeck
- Trauma Department, Hannover Medical School, Hannover, Germany;
| | - Marco Haertlé
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Tilman Graulich
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Max Ettinger
- Orthopedic Surgery Department, Hannover Medical School, Hannover, Germany
| | - Eduardo M Suero
- Department of General Trauma and Reconstructive Surgery, Ludwig-Maximilians-University, Munich, Germany
| | | | - Mohamed Omar
- Trauma Department, Hannover Medical School, Hannover, Germany
| |
Collapse
|
4
|
Albert JD, Le Corvec M, Berthoud O, David C, Guennoc X, Hoppe E, Jousse-Joulin S, Le Goff B, Tariel H, Sire O, Jolivet-Gougeon A, Coiffier G, Loréal O. Ruling out septic arthritis risk in a few minutes using mid-infrared spectroscopy in synovial fluids. Rheumatology (Oxford) 2021; 60:1158-1165. [PMID: 32885254 DOI: 10.1093/rheumatology/keaa373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/19/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to show the usefulness of a mid-infrared fibre evanescent wave spectroscopy point of care device in the identification of septic arthritis patients in a multicentre cohort, and to apply this technology to clinical practice among physicians. METHODS SF samples from 402 patients enrolled in a multicentre cohort were frozen for analysis by mid-infrared fibre evanescent wave spectroscopy. The calibration cohort was divided into two groups of patients (septic arthritis and non-septic arthritis) and relevant spectral variables were used for logistic regression model. Model performances were tested on an independent set of 86 freshly obtained SF samples from patients enrolled in a single-centre acute arthritis cohort and spectroscopic analyses performed at the patient's bedside. RESULTS The model set-up, using frozen-thawed SFs, provided good performances, with area under the curve 0.95, sensitivity 0.90, specificity 0.90, positive predictive value 0.41 and negative predictive value 0.99. Performances obtained in the validation cohort were area under the curve 0.90, sensitivity 0.92, specificity 0.81, positive predictive value 0.46 and negative predictive value 0.98. The septic arthritis probability has been translated into a risk score from 0 to 4 according to septic risk. For a risk score of 0, the probability of identifying a septic patient is very low (negative predictive value of 1), whereas a risk score of 4 indicates very high risk of septic arthritis (positive predictive value of 1). CONCLUSION Mid-infrared fibre evanescent wave spectroscopy could distinguish septic from non-septic synovial arthritis fluids with good performances, and showed particular usefulness in ruling out septic arthritis. Our data supports the possibility of technology transfer. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT02860871.
Collapse
Affiliation(s)
- Jean-David Albert
- Rheumatology Department, Centre Hospitalier Universitaire de Rennes, Rennes, France.,INSERM, Université de Rennes, INRAe, UMR 1241, Institut NUMECAN CHU Rennes, Rennes, France
| | | | - Olivia Berthoud
- Rheumatology Department, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Claire David
- Rheumatology Department, Centre Hospitalier de Bretagne Atlantique, Vannes, France
| | - Xavier Guennoc
- Rheumatology Department, Centre Hospitalier St-Brieuc, St-brieuc, France
| | - Emmanuel Hoppe
- Rheumatology Department, Centre Hospitalier Universitaire Angers, Angers, France
| | - Sandrine Jousse-Joulin
- Rheumatology Department, Centre Hospitalier Universitaire and Inserm, LBAI, UMR1227, Brest, France
| | - Benoît Le Goff
- Rheumatology Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | | | | | - Anne Jolivet-Gougeon
- INSERM, Université de Rennes, INRAe, UMR 1241, Institut NUMECAN CHU Rennes, Rennes, France
| | - Guillaume Coiffier
- Rheumatology Department, Centre Hospitalier Universitaire de Rennes, Rennes, France.,INSERM, Université de Rennes, INRAe, UMR 1241, Institut NUMECAN CHU Rennes, Rennes, France
| | - Olivier Loréal
- INSERM, Université de Rennes, INRAe, UMR 1241, Institut NUMECAN CHU Rennes, Rennes, France
| |
Collapse
|
5
|
Synovial fluid analysis with leukocyte esterase reagent strip test. Clin Rheumatol 2021; 40:3279-3283. [PMID: 33527167 DOI: 10.1007/s10067-021-05608-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
To determine whether leukocyte esterase reagent strip test (LERST) analysis could help distinguish inflammatory arthritis from mechanical joint effusion. We analyzed synovial fluid (SF) from consecutive patients with a non-traumatic joint effusion during a 6-month period. Inflammatory SF was defined by white blood cell (WBC) count ≥ 2000/mm3. The LERST was performed with both semi-quantitative visual analysis (VA) and automated colorimetric reader (ACR) analysis. Leukocytes ≥ 1+ was considered a positive LERST result and WBC count was the reference. We obtained 100 SF samples (87 knees, 7 ankles, 5 hips, and 1 elbow) from 100 patients (mean ± SD age 61 ± 17 years, 59% men). The laboratory analyzed 88 SF samples (37 mechanical and 51 inflammatory). The remaining 12 SF samples were 10 hemarthrosis not allowing LERST analysis and 2 samples with coagulum not allowing WBC count. As compared with the laboratory analysis, the LERST had sensitivity and specificity 55% and 89% with VA and 47% and 92% with ACR analysis. The positive and negative predictive values were 87.5% and 59% with VA and 89% and 55% with ACR analysis. We found almost perfect agreement between VA and ACR results (kappa 0.70 [95% CI 0.50-0.90]). The WBC count increased with number of + observed after VA. Our results confirm that the LERST is able to detect inflammation in SF of native joints, thereby representing a useful and cheap tool in primary care. Its low sensitivity limits its use for ruling out inflammatory disorders. Key Points • Reagent strip tests can detect inflammation in synovial fluid. • In primary care practice, this method is cheap and easy to do.
Collapse
|
6
|
Nguyen DT, Soeranaya BHT, Truong THA, Dang TT. Modular design of a hybrid hydrogel for protease-triggered enhancement of drug delivery to regulate TNF-α production by pro-inflammatory macrophages. Acta Biomater 2020; 117:167-179. [PMID: 32977069 DOI: 10.1016/j.actbio.2020.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/28/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023]
Abstract
Systemic drug administration has conventionally been prescribed to alleviate persistent local inflammation which is prevalent in chronic diseases. However, this approach is associated with drug-induced toxicity, particularly when the dosage exceeds that necessitated by pathological conditions of diseased tissues. Herein, we developed a modular hybrid hydrogel which could be triggered to release an anti-inflammatory drug upon exposure to elevated protease activity associated with inflammatory diseases. Modular design of the hybrid hydrogel enabled independent optimization of its protease-cleavable and drug-loaded subdomains to facilitate hydrogel formation, cleavability by matrix-metalloprotease-9 (MMP-9), and tuning drug release rate. In vitro study demonstrated the protease-triggered enhancement of drug release from the hybrid hydrogel system for effective inhibition of TNF-α production by pro-inflammatory macrophages and suggested its potential to mitigate drug-induced cytotoxicity. Using non-invasive imaging to monitor the activity of reactive oxygen species in biomaterial-induced host response, we confirmed that the hybrid hydrogel and its constituent materials did not induce adverse immune response after 5 days following their subcutaneous injection in immuno-competent mice. We subsequently incorporated this hybrid hydrogel onto a commercial wound dressing which could release the drug upon exposure to MMP-9. Together, our findings suggested that this hybrid hydrogel might be a versatile platform for on-demand drug delivery via either injectable or topical application to modulate inflammation in chronic diseases.
Collapse
|
7
|
Berthoud O, Coiffier G, Albert JD, Gougeon-Jolivet A, Goussault C, Bendavid C, Guggenbuhl P. Performance of a new rapid diagnostic test the lactate/glucose ratio of synovial fluid for the diagnosis of septic arthritis. Joint Bone Spine 2020; 87:343-350. [PMID: 32234547 DOI: 10.1016/j.jbspin.2020.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance of the synovial lactate, glucose and lactate/glucose ratio assay for the diagnosis of septic arthritis. METHODS In this monocentric cross-sectional study, synovial fluids were prospectively obtained from patients with acute joint effusion (<30 days) on native joint. Septic arthritis was defined using Newman's criteria. To evaluate diagnostic performance, Receiver Operating Characteristic (ROC) curves with Area under the curve (AUC), Sensitivities (Se), Specificities (Sp), LR+ their 95% confidence intervals were calculated. Synovial fluid cultures with gram staining, crystal analyses, synovial fluid white blood cell counts (WBC), lactate and glucose assays were performed. RESULTS A total of 233 synovial fluids were included. 25 patients had septic arthritis and 208 had non-septic arthritis (104 crystal-induced arthritis, 15 RA, 8 SpA, 6 reactive arthritis, and 75 acute arthritis of undifferentiated origin). Synovial lactate/glucose ratio performed higher than the synovial lactate or glucose assay separately (AUC: 0.859 [0.772-0.945]). Best synovial lactate/glucose ratio threshold to differentiate septic arthritis from non-septic arthritis was 5 Se 52% [0.34-0.7], Sp 98.1% [0.95-0.99], LR+ 27.0[9.50-76.00]). CONCLUSION The diagnostic performance of synovial lactate/glucose allows septic arthritis to be effectively and very quickly distinguished from other types of arthritis.
Collapse
Affiliation(s)
- Olivia Berthoud
- Department of Rheumatology, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - Guillaume Coiffier
- Department of Rheumatology, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; UMR Inserm U 1241, University of Rennes, Rennes, France
| | - Jean-David Albert
- Department of Rheumatology, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; UMR Inserm U 1241, University of Rennes, Rennes, France
| | - Anne Gougeon-Jolivet
- UMR Inserm U 1241, University of Rennes, Rennes, France; Bacteriology Laboratory, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Claire Goussault
- Department of Rheumatology, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Claude Bendavid
- Department of Biochemistry, Rennes University Hospital - Pontchaillou, 2, rue Henri-LeGuilloux, 35000 Rennes, France; Inserm unité mixte de recherche 991, 35043 Rennes, France
| | | |
Collapse
|
8
|
Hassas Yeganeh M, Talaei M, Bazzaz AE, Rahmani K, Sinaei R, Fathi M, Shiari R, Hosseinzadeh H. Determination of diagnostic value (validity) leukocyte esterase (urine dipstick strip) in differentiating inflammatory arthritis from bacterial arthritis. Adv Rheumatol 2020; 60:11. [PMID: 31992368 DOI: 10.1186/s42358-020-0115-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 01/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The current diagnostic cornerstone for septic arthritis contains gram stains, bacterial culture, and cell count with a differential of aspirated synovial fluid. Recently, a synovial leukocyte esterase (LE) test has been used for diagnosing septic arthritis. Since this test measures the esterase activity of leukocytes, there is always a dilemma for using this test in patients with inflammatory arthritis. METHODS We collected the synovial fluid specimens as part of the general diagnostic protocol for patients suspected of Juvenile Idiopathic Arthritis (JIA) or Septic Arthritis (SA). Each group included 34 patients. We compared the result of the synovial LE test with the result of the culture of each patient. RESULTS The mean ages of patients were 64.14 ± 31.27 and 50.88 ± 23.19 months in the JIA group and septic arthritis group, respectively. The LE test results were positive in 30 specimens, trace in 3 and negative in one in the first-time test and were positive in 31 specimens and trace in 3 in the second-time test, while it was negative in all patients with JIA. Hence, the sensitivity of the synovial LE test was 80.8%, the specificity, PPV, and NPV were 78.6, 70.0, 86.8% respectively based on a positive culture. CONCLUSION The leukocyte esterase strip test can be used as a rapid, bedside method for diagnosing or excluding bacterial infections in different body fluids. The synovial LE test can be used as an accurate test to rapidly rule in or out an acute articular bacterial infection, even in patients with concurrent inflammatory arthritis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Hamid Hosseinzadeh
- Orthopedic Research Group, School of Osteopathic Medicine, Rowan University, 201 S Broadway, Camden, NJ, 08103, USA.
| |
Collapse
|
9
|
Kheir MM, Ackerman CT, Tan TL, Benazzo A, Tischler EH, Parvizi J. Leukocyte Esterase Strip Test Can Predict Subsequent Failure Following Reimplantation in Patients With Periprosthetic Joint Infection. J Arthroplasty 2017; 32:1976-1979. [PMID: 28215967 DOI: 10.1016/j.arth.2017.01.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/29/2016] [Accepted: 01/17/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Leukocyte esterase (LE) strip test is an accurate marker for diagnosing periprosthetic joint infection (PJI). This study aims to determine if LE is a good predictor of persistent infection and/or subsequent failure in patients undergoing reimplantation. METHODS This single-institution study prospectively recruited and retrospectively analyzed 109 patients who underwent two-stage exchange treatment of PJI, from 2009-2016, and had an LE test performed at time of reimplantation. LE results of "2+" were considered positive. Ninety-five patients had 90-day minimum follow-up to assess treatment failure, defined by Delphi criteria. Eighteen patients were excluded due to blood contamination of LE test, resulting in a final cohort of 77 patients (mean follow-up 1.76 years). RESULTS Of the final cohort, 19 patients (24.7%) experienced subsequent failure. At reimplantation, LE test was positive in 22.2% of culture-positive and 4.4% of culture-negative cases. The LE test was negative in all patients who had not failed at latest follow-up, yielding sensitivity, specificity, positive predictive value, negative predictive value, and AUC of 26.3%, 100%, 100%, 87.5%, and 0.632, respectively; in comparison, MSIS criteria respectively yielded 25.0%, 87.3%, 27.6%, 85.8%, and 0.562 (P = .01 for specificity). Kaplan-Meier curves revealed higher failure rate in patients who had a positive LE test at time of reimplantation (P < .001). CONCLUSION There is a dire need for an accurate diagnostic test to determine optimal timing of reimplantation in patients undergoing surgical treatment for PJI. The current study suggests that a positive LE test may be indicative of persistence of infection and results in a higher rate of subsequent failure.
Collapse
Affiliation(s)
- Michael M Kheir
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Colin T Ackerman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Timothy L Tan
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrea Benazzo
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eric H Tischler
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Javad Parvizi
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
10
|
De Vecchi E, Villa F, Bortolin M, Toscano M, Tacchini L, Romanò CL, Drago L. Leucocyte esterase, glucose and C-reactive protein in the diagnosis of prosthetic joint infections: a prospective study. Clin Microbiol Infect 2016; 22:555-60. [PMID: 27040804 DOI: 10.1016/j.cmi.2016.03.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 03/15/2016] [Accepted: 03/19/2016] [Indexed: 11/30/2022]
Abstract
Analysis of joint fluid is of paramount importance for the diagnosis of prosthetic joint infections. Different markers of inflammation and/or infection in joint fluid have been proposed for diagnosis of these infections. In this study we evaluated the performance of leucocyte esterase, C-reactive protein (CRP) and glucose assays in synovial fluids from 129 patients with septic (n = 27) or aseptic (n = 102) prosthetic joint failure. Samples were collected in serum tubes and centrifuged to limit the presence of corpuscle interfering with the assays. Determinations of leucocyte esterase and glucose were carried out by means of enzymatic colorimetric reactions performed on strips for urine analysis. Tests were considered positive when graded + or ++ whereas traces or absence of colour were considered negative. CRP was measured using an automated turbidimetric method and considered suggestive for infections when >10 mg/L. Leucocyte esterase was positive in 25/27 infected patients and negative in 99/102 not infected patients (sensitivity 92.6%, specificity 97.0%). CRP was higher than the threshold in 22/27 infected patients and in 6/102 not infected patients (sensitivity: 81.5%; specificity: 94.1%) whereas glucose showed the lowest sensitivity (77.8%) and specificity (81.4%), being negative in 21/27 and 19/102 infected and not infected patients, respectively. CRP led to a correct diagnosis in 19 of 22 patients with discordant esterase and glucose results. In conclusion, evaluation of leucocyte esterase, glucose and CRP may represent a useful tool for rapid diagnosis of prosthetic joint infections.
Collapse
Affiliation(s)
- E De Vecchi
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - F Villa
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - M Bortolin
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - M Toscano
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy; Laboratory of Clinical Microbiology, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - L Tacchini
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - C L Romanò
- Department of Bone and Joint Infections and Reconstructive Surgery, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - L Drago
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy; Laboratory of Clinical Microbiology, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| |
Collapse
|
11
|
Albert JD, Monbet V, Jolivet-Gougeon A, Fatih N, Le Corvec M, Seck M, Charpentier F, Coiffier G, Boussard-Pledel C, Bureau B, Guggenbuhl P, Loréal O. A novel method for a fast diagnosis of septic arthritis using mid infrared and deported spectroscopy. Joint Bone Spine 2015; 83:318-23. [PMID: 26677999 DOI: 10.1016/j.jbspin.2015.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/28/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the ability of mid infrared deported spectroscopy to discriminate synovial fluids samples of septic arthritis patients from other causes of joint effusion. METHODS Synovial fluids obtained from patients with clinically suspected arthritis were collected, analysed and classified according to standard diagnostic procedures as septic or non-septic. A spectroscopic analysis on synovial fluid samples was then performed using a coiled optical fiber made with chalcogenide glass. After a factorial analysis of the normalized spectra and the computation of a Fisher test used to select the most relevant components, a logistic regression model was fitted, allowing to attribute a score between 0 - non-septic -, and 1 - septic. RESULTS In a first phase, we analysed the synovial fluids from 122 different synovial fluids including 6 septic arthritis among arthritis of various origins. Septic synovial fluids were identified with a sensitivity of 95.8% and a specificity of 93.9% and an AUROC of 0.977. The analysis of an independent set of samples (n=42, including two septic arthritis) gave similar values. CONCLUSIONS Our data strongly supports the interest of mid infrared deported spectroscopy, which could be used potentially at point of care, for a rapid and easy diagnosis of septic arthritis. Now, the precision of the diagnosis must be evaluated through a multicentric study on a larger panel of patients.
Collapse
Affiliation(s)
- Jean-David Albert
- Department of Rheumatology, CHU of Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM UMR 991, 35033 Rennes, France.
| | - Valérie Monbet
- University of Rennes 1, 35043 Rennes, France; UMR-CNRS 6625, IRMAR Mathematics Research Institute of Rennes, 35033 Rennes, France; INRIA/ASPI, 35033 Rennes, France
| | - Anne Jolivet-Gougeon
- Pole of Biology, EA 1254 Microbiologie, CHU of Rennes, University of Rennes 1, 35033 Rennes, France
| | - Nadia Fatih
- Diafir™, avenue Chardonnet, Parc Lorans, 26J, 35700 Rennes, France
| | - Maëna Le Corvec
- Diafir™, avenue Chardonnet, Parc Lorans, 26J, 35700 Rennes, France; Laboratoire d'Ingénierie des Matériaux de Bretagne (LIMATB), University of Bretagne-Sud, CER Yves-Coppens, BP 573, 56017 Vannes cedex, France
| | - Malik Seck
- University of Rennes 1, 35043 Rennes, France
| | | | - Guillaume Coiffier
- Department of Rheumatology, CHU of Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM UMR 991, 35033 Rennes, France
| | | | - Bruno Bureau
- ISCR UMR-CNRS 6226, Verres et Céramiques, Université de Rennes 1, 35042 Rennes, France
| | - Pascal Guggenbuhl
- Department of Rheumatology, CHU of Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France; INSERM UMR 991, 35033 Rennes, France; University of Rennes 1, 35043 Rennes, France
| | - Olivier Loréal
- INSERM UMR 991, 35033 Rennes, France; University of Rennes 1, 35043 Rennes, France
| |
Collapse
|