Counting leukocytes in expressed prostatic secretions from patients with chronic prostatitis/chronic pelvic pain syndrome

Periprosthetic infection: where do we stand with regard to Gram stain?

BACKGROUND AND PURPOSE

One of the routinely used intraoperative tests for diagnosis of periprosthetic infection (PPI) is the Gram stain. It is not known if the result of this test can vary according to the type of joint affected or the number of specimen samples collected. We examined the role of this diagnostic test in a large cohort of patients from a single institution.

MATERIALS AND METHODS

A positive gram stain was defined as the visualization of bacterial cells or "many neutrophils" (> 5 per high-power field) in the smear. The sensitivity, specificity, and predictive values of each individual diagnostic arm of Gram stain were determined. Combinations were performed in series, which required both tests to be positive to confirm infection, and also in parallel, which necessitated both tests to be negative to rule out infection.

RESULTS

The presence of organisms and "many" neutrophils on a Gram smear had high specificity (98-100%) and positive predictive value (89-100%) in both THA and TKA. The sensitivities (30-50%) and negative predictive values (70-79%) of the 2 tests were low for both joint types. When the 2 tests were combined in series, the specificity and positive predictive value were absolute (100%). The sensitivity and the negative predictive value improved for both THA and TKA (43-64% and 82%, respectively).

INTERPRETATION

Although the 2 diagnostic arms of Gram staining can be combined to achieve improved negative predictive value (82%), Gram stain continues to have little value in ruling out PPI. With the advances in the field of molecular biology, novel diagnostic modalities need to be designed that can replace these traditional and poor tests.

Two-year experience with the german-translated version of the NIH-CPSI in patients with CP/CPPS

OBJECTIVES

To examine, after psychometric evaluation and validation of the translated National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the practical value of this questionnaire in a routine diagnostic prostatitis setup for patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The NIH-CPSI is a well-accepted tool for the symptomatic evaluation of patients with CP/CPPS. The recently translated German version has not yet been validated in detail.

METHODS

A total of 137 consecutive patients attending a prostatitis outpatient department were classified according to the internationally accepted NIH consensus classification into CP/CPPS NIH type IIIA (n = 53; mean age 43.2 years) and IIIB (n = 84; mean age 43.4 years). For psychometric analysis, the overall type III group was evaluated for reliability and validity of the German NIH-CPSI. The psychometric properties of the translated NIH-CPSI were compared with those of the original English version. In addition, the total scores of all men and separately for CP/CPPS NIH types IIIA and IIIB were evaluated.

RESULTS

The German NIH-CPSI was reliable, with an alpha coefficient for the overall index and its subscales of between 0.60 and 0.74. However, the internal consistency of the pain subdomain was lower in our translated version (alpha 0.60) compared with the original English version (alpha 0.86). In this cohort, men with NIH type IIIB CP/CPPS were significantly (P = 0.03) more symptomatic in the total index compared with men with NIH type IIIA CP/CPPS.

CONCLUSIONS

The German version of the NIH-CPSI has a relatively high reliability and face and construct validity overall. A validated translated NIH-CPSI is suggested as a standardized tool to quantify chronic pelvic pain symptoms for different countries and languages.