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Zou Y, Yang Y, Yang J, Zhang Y, Zhao C, Qin L, Hu N. The Utility of Synovial Fluid Interleukin-10 in Diagnosing Chronic Periprosthetic Joint Infection: A Prospective Cohort Study. Infect Drug Resist 2025; 18:533-542. [PMID: 39898353 PMCID: PMC11786602 DOI: 10.2147/idr.s490962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 01/10/2025] [Indexed: 02/04/2025] Open
Abstract
Background Diagnosing chronic periprosthetic joint infection (PJI) is challenging. Synovial fluid interleukin-10 (SF IL-10), an anti-inflammatory cytokine produced by leukocytes, plays a pivotal role in inflammation and infection regulation. However, limited research has explored the diagnostic potential of SF IL-10 in chronic PJI patients. Objective The study aimed to investigate the relationship between SF IL-10 and incidence of chronic PIJ, and to evaluate its diagnostic reliability. Design and Methods We analyzed data from 137 patients who underwent revision surgery for aseptic loosening or chronic PJI between 2017 and 2019 in our hospital. PJI diagnoses followed the 2013 International Consensus Meeting criteria. We measured serum ESR, serum CRP, SF PMN%, SF WBC and SF IL-10 levels, using logistic regression and receiver operating characteristic (ROC) curves to evaluate associations and diagnostic accuracy. Results Demographic data showed no significant differences. However, SF IL-10 levels differed significantly between groups. Logistic regression indicated a strong association between SF IL-10 and chronic PJI (OR = 1.11, 95% CI 1.05~1.17, p < 0.001). At a cut-off of 10.305 pg/mL, SF IL-10 had an area under the ROC curve (AUC) of 0.891, with 92.16% sensitivity and 77.91% specificity. Adding SF IL-10 to traditional models improved risk prediction for chronic PJI (net reclassification improvement [NRI]: 0.167 [0.023 ~ 0.312]; integrated discrimination improvement [IDI]: 0.160 [0.096 ~ 0.224]). Conclusion Higher SF IL-10 levels were significantly associated with chronic PJI in revision surgery patients, and incorporating SF IL-10 into the traditional risk model enhanced its predictive value for chronic PJI in these patients.
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Affiliation(s)
- Yinshuang Zou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Department of Orthopedics, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, 434000, People’s Republic of China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Yaji Yang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Jianye Yang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Yanhao Zhang
- National Engineering Research Center of Immunological Products, Department of Microbiology and Biochemical Pharmacy, College of Pharmacy, Army Medical University, Chongqing, 400038, People’s Republic of China
| | - Chen Zhao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Leilei Qin
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Ning Hu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
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Sznajder W, Jankowska-Polańska B, Tański W. A Narrative Review of Fungal Periprosthetic Joint Infections of the Hip and Knee: Risk Factors, Microbiological Profiles, and Treatment Challenges. J Clin Med 2025; 14:206. [PMID: 39797289 PMCID: PMC11721793 DOI: 10.3390/jcm14010206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 12/23/2024] [Accepted: 12/28/2024] [Indexed: 01/13/2025] Open
Abstract
Fungal periprosthetic joint infections (PJIs) are rare but increasingly recognized complications following total joint arthroplasty (TJA). While Candida albicans remains the most common pathogen, non-albicans Candida species and other fungi, such as Aspergillus, have gained prominence. These infections often present with subtle clinical features and affect patients with significant comorbidities or immunosuppression. Compared to bacterial PJIs, fungal infections pose unique diagnostic and therapeutic challenges, including biofilm formation, limited antifungal susceptibility, and protracted treatment courses. This narrative review synthesizes current evidence from research articles and review/metanalysis papers, focusing on fungal PJIs. The literature search encompassed publications from 2015 to 2024, identifying key insights on epidemiology, risk factors, microbiological profiles, diagnostic methods, therapeutic strategies, and outcomes. Both classical references and recent studies addressing emerging diagnostic biomarkers and biofilm-active therapies were included. It was shown that C. albicans remains the primary fungal pathogen in PJIs but non-albicans Candida species and other fungi are associated with more complex clinical scenarios, higher recurrence rates, and reduced infection-free survival. Patients commonly exhibit multiple comorbidities, compromised immune status, and previous prosthetic revisions. Diagnosis is complicated by slow-growing organisms and nonspecific inflammatory markers, prompting interest in novel diagnostics such as alpha-defensin, calprotectin, and next-generation sequencing. Two-stage revision arthroplasty, supplemented by prolonged targeted antifungal therapy, is considered the gold standard for chronic infections, although outcomes remain inferior to bacterial PJIs. Emerging strategies, including antifungal-impregnated beads and biofilm-disrupting agents, may improve local infection control. In conclusion, fungal PJIs constitute a challenging clinical entity demanding tailored diagnostic and therapeutic approaches. Further research into standardized diagnostic criteria, optimized antifungal regimens, biomarker validation, and refined surgical strategies is essential. Multidisciplinary collaboration, enhanced patient optimization, and innovative biofilm-directed therapies hold promise for improving outcomes and reducing the burden of fungal PJIs.
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Affiliation(s)
- Wojciech Sznajder
- Department of Orthopedics and Traumatology, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland
| | | | - Wojciech Tański
- Department of Internal Medicine, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland;
- Faculty of Medicine, Wrocław University of Science and Technology, 50-376 Wroclaw, Poland
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Röhrl A, Klawonn F, Füchtmeier B, Wulbrand C, Gessner A, Zustin J, Ambrosch A. Results of a monocentric field study: value of histology compared to sonication method and conventional tissue culture in the diagnosis of periprosthetic joint infection (PJI). Infection 2024; 52:2287-2296. [PMID: 38730201 DOI: 10.1007/s15010-024-02278-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/21/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Alexander Röhrl
- Department of Trauma Surgery, Orthopaedics & Sports Medicine, Hospital of Brothers of Mercy, Regensburg, Germany
| | - Frank Klawonn
- Biostatistics, Helmholtz Centre for Infection Research, Brunswick, Germany
- Institute for Information Engineering, Ostfalia University, Wolfenbüttel, Germany
| | - Bernd Füchtmeier
- Department of Trauma Surgery, Orthopaedics & Sports Medicine, Hospital of Brothers of Mercy, Regensburg, Germany
| | - Christian Wulbrand
- Department of Trauma Surgery, Orthopaedics & Sports Medicine, Hospital of Brothers of Mercy, Regensburg, Germany
| | - Andre Gessner
- Institute of Clinical Microbiology and Infection Prevention, University Hospital, Regensburg, Germany
| | - Jozef Zustin
- Private Histopathology Service, Regensburg, Germany
- Gerhard Domagk Institute of Pathology, University Medical Center, Münster, Germany
| | - Andreas Ambrosch
- Institute of Laboratory Medicine, Microbiology and Infection Prevention, Hospital of Brothers of Mercy, Prüfeninger Straße 86, 93049, Regensburg, Germany.
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Guo D, Shen D, Dong Y. The Predictive Value of Heparin-Binding Protein in Total Joint Arthroplasty Prosthesis Infections. Surg Infect (Larchmt) 2024. [PMID: 39602249 DOI: 10.1089/sur.2024.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2024] Open
Abstract
Objective: This study aims to explore the predictive value of heparin-binding protein (HBP) in diagnosing prosthesis infections after total joint arthroplasty (TJA), in order to provide a new biomarker for early identification and management of prosthetic joint infections (PJI) post-TJA. Methods: A retrospective analysis of data from 168 patients who underwent TJA revision at Lianyungang First People's Hospital from October 2020 to March 2024 was conducted. The participants were divided into an infection group (38 cases) and a non-infection group (94 cases). Inclusion criteria included all patients undergoing joint prosthesis revision who had preoperative HBP levels measured. Primary assessment parameters included HBP, C-reactive protein (CRP), white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR). Univariate analysis and multivariate regression analysis were used to evaluate the correlation of these factors with PJI, and the performance of HBP in predicting PJI was analyzed using the receiver operating characteristic (ROC) curve. Results: There were significant statistical differences in HBP, CRP, WBC, and ESR between the infection and non-infection groups (p < 0.05). Multivariate regression analysis showed that HBP is an independent predictive factor for the risk of PJI. The area under the ROC curve was 0.856, indicating that HBP has good predictive performance. The optimal cutoff value for HBP was 51.3, with a sensitivity of 69.2% and a specificity of 89.5%. Conclusion: The study found that HBP levels are significantly associated with the occurrence of PJI following TJA, serving as an effective independent predictive factor for PJI risk. HBP has high predictive value and can be considered an important biomarker for predicting PJI post-TJA in clinical settings, aiding in the early identification and management of PJI, thereby improving patient treatment outcomes and quality of life.
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Affiliation(s)
- Dongsheng Guo
- The First People's Hospital of Lianyungang, Lianyungang City, China
| | - Dahui Shen
- Lianyungang Clinical College of Nanjing Medical University, Lianyungang City, China
| | - Yuefu Dong
- The First People's Hospital of Lianyungang, Lianyungang City, China
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Natoli RM, Malek S. Fracture-related infection blood-based biomarkers: Diagnostic strategies. Injury 2024; 55 Suppl 6:111823. [PMID: 39164161 DOI: 10.1016/j.injury.2024.111823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/30/2024] [Accepted: 08/10/2024] [Indexed: 08/22/2024]
Abstract
Fracture-related infections are significant postoperative complications that carry substantial patient burden and additional healthcare costs. Despite their impact on outcome, early diagnosis of these infections remains challenging due to current available tests lacking acceptable diagnostic parameters. This review compiles existing information on blood-based biomarkers that have been evaluated as early diagnostic tools and highlights the challenges in their reliability. To begin to overcome these challenges new avenues of biomarker discovery utilizing "omics" technologies and novel analytical methods are being investigated in recent years. It appears that, despite their complexity, these newer approaches may be the future in biomarker discovery for fracture-related infection diagnosis.
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Affiliation(s)
- Roman M Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Sarah Malek
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
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Zhang Q, Sun X, Pan JB, Kong G. Feasibility of mNGS in joint replacement patients exhibiting elevated ESR and CRP levels without an underlying diagnosis. Eur J Med Res 2024; 29:515. [PMID: 39456072 PMCID: PMC11515214 DOI: 10.1186/s40001-024-02118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 10/16/2024] [Indexed: 10/28/2024] Open
Abstract
OBJECTIVE The aim of this study is to investigate the viability of performing initial artificial joint replacement surgery in patients presenting with unexplained elevations in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. METHODS A cohort of 22 patients, comprising 11 cases each for knee and hip joint replacements, who underwent initial artificial joint replacement surgery between November 2020 and January 2022, was recruited. All patients exhibited elevated levels of ESR and CRP prior to surgery, the etiology of which remained undetermined. Intraoperatively, joint effusion and periarticular tissues were preserved for subsequent bacterial culture and metagenomic next-generation sequencing (mNGS). Postoperatively, a combination of intravenous and local antibiotics was administered for anti-infective management. In cases where bacterial culture and/or mNGS yielded positive results, patients were diagnosed with periprosthetic joint infections (PJI) and underwent one-stage revision; conversely, negative findings led to the discontinuation of intravenous and local antibiotics therapy. RESULTS Among the cohort of 22 patients, bacterial cultures yielded negative results, while mNGS identified bacterial infection in 14 patients (63.63%), viral infection in 1 patient (4.55%), and yielded negative results in 7 patients (31.82%). All surgical incisions achieved per primam. Subsequent follow-up assessments conducted for more than 1 year postoperatively revealed absence of PJI among the patients, all of whom exhibited satisfactory progress in their rehabilitation exercises. Notably, the Knee Society Score (KSS) for knee joint patients significantly improved from a preoperative mean of 48.7 ± 3.3 points to 84.3 ± 2.2 points postoperatively, whereas the Harris Hip Score for hip joint patients increased significantly from preoperative mean of 50.6 ± 3.6 points to 87.1 ± 1.6 points (P < 0.01). CONCLUSION In cases where patients present with unexplained elevations in ESR and CRP levels, primary artificial joint replacement can be undertaken following a one-stage revision approach for PJI.
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Affiliation(s)
- Qi Zhang
- Department of Osteoarthritis, Yantai City Yantai Shan Hospital, No. 91 of Jiefang Road, Zhifu District, Yantai, 264001, China
| | - Xuan Sun
- Pharmacy Intravenous Admixture Services, Yantai City Yantai Shan Hospital, No. 91 of Jiefang Road, Zhifu District, Yantai, 264001, China
| | - Jing-Bo Pan
- Department of Osteoarthritis, Yantai City Yantai Shan Hospital, No. 91 of Jiefang Road, Zhifu District, Yantai, 264001, China
| | - Gang Kong
- Department of Osteoarthritis, Yantai City Yantai Shan Hospital, No. 91 of Jiefang Road, Zhifu District, Yantai, 264001, China.
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7
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Fu Y, Li Q, Zhao H, Liu W. Construction and evaluation of a combined diagnostic model for chronic periprosthetic joint infection based on serological tests. J Orthop Surg Res 2024; 19:667. [PMID: 39415257 PMCID: PMC11484210 DOI: 10.1186/s13018-024-05146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 10/05/2024] [Indexed: 10/18/2024] Open
Abstract
BACKGROUND Early diagnosis of chronic periprosthetic joint infection (CPJI) is crucial for ensuring effective treatment and improving patient outcomes. However, many auxiliary diagnostic tests are challenging to implement on a large scale due to economic and technical constraints, making CPJI diagnosis difficult. This study aims to design and validate a combined diagnostic model based on commonly used serological tests to evaluate its diagnostic value for CPJI and develop a diagnostic nomogram. METHODS A retrospective study from January 2019 to February 2024 involving 170 patients undergoing knee and hip arthroplasty revision for CPJI and aseptic loosening (AL) was conducted across two medical centers. These patients were divided into the training set and validation set. Patients were categorized into CPJI and AL groups based on infection status. Serological tests conducted upon admission were collected, and single-factor and multi-factor logistic regression analyses were used to identify independent diagnostic factors for early infection. These factors were integrated to construct a nomogram model. The model's performance was evaluated using the receiver operating characteristic area under the curve (AUC), Hosmer-Lemeshow test, decision curve analysis (DCA), and calibration curve, with external validation conducted on the validation set. RESULTS Multivariate logistic regression analysis showed that C-reactive protein (CRP), procalcitonin (PCT), and Platelet count/mean platelet volume ratio (PVR) were independent diagnostic factors for CPJI (p < 0.05). The AUCs for diagnosing CPJI using these individual factors were 0.806, 0.616, and 0.700 (p < 0.05), respectively, while their combined detection achieved an AUC of 0.861 (p < 0.05). The DCA clinical impact curve shows the combined model has good clinical utility when the threshold probability of infection presence is between 0.16 and 0.95. Similar results were obtained in the external validation cohort, with the combined detection having an AUC of 0.893. CONCLUSION The combined diagnostic model of CRP, PCT, and PVR significantly improves the The combined diagnostic model of CRP, PCT, and PVR significantly improves the diagnostic performance for CPJI compared to individual serum biomarkers. It exhibits good sensitivity, specificity, and clinical applicability, providing valuable references for CPJI diagnosis.
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Affiliation(s)
- Yingqiang Fu
- Department of Joint Surgery/Sports Medicine, The Second Hospital Of Shandong University, Jinan, 250033, China
| | | | - Heng Zhao
- Department of Joint Surgery/Sports Medicine, The Second Hospital Of Shandong University, Jinan, 250033, China
| | - Wenguang Liu
- Department of Joint Surgery/Sports Medicine, The Second Hospital Of Shandong University, Jinan, 250033, China.
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Maritati M, De Rito G, Rosta V, Cervellati C, Manfrinato MC, Zanoli GA, De Giorgio R, Guarino M, Costanzini A, Contini C, Ning Y, Trampuz A, Trentini A. Active myeloperoxidase: a promising biomarker to differentiate "acute" and "low-grade" peri-prosthetic joint infections from aseptic failures. Front Microbiol 2024; 15:1417049. [PMID: 38912350 PMCID: PMC11190362 DOI: 10.3389/fmicb.2024.1417049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction The accurate distinction between periprosthetic joint infections (PJI) and aseptic failures (AF) is of paramount importance due to differences in treatment. However, this could be challenging by using the current criteria. Various synovial fluid biomarkers are being assessed to improve the diagnostic accuracy. Myeloperoxidase (MPO), an enzyme contained in the granules of neutrophils, may be a promising biomarker for PJI. Methods Synovial fluids of 99 patients (n = 65 PJI according to EBJIS criteria; n = 34 AF) were collected in two specialized orthopedic centers. PJI were divided into acute (n = 33) and low-grade (n = 32) according to previously published classification. An activity assay specific for active MPO was performed in each sample. Ability of MPO to correctly discriminate patients with PJI from AF was determined by ROC analysis. The best discriminating cut-off value was determined by calculating the J Youden index. For all analyses, a P value < 0.05 was considered statistically significant. Results Active MPO was higher in PJI than AF (P < 0.0001). The ROC analysis revealed a significant area under the curve (AUC: 0.86; 95% CI: 0.78-0.93, P < 0.0001). A cut-off value of 561.9 U/mL, with good sensitivity (0.69) and specificity (0.88), discriminated between AF and PJI (accuracy 75.76%, 95% CI: 66.11-83.81%, positive likelihood ratio 5.88, 95% CI: 2.31-14.98 and negative likelihood ratio 0.35, 95%CI: 0.24-0.51). No difference in MPO levels was found between acute and chronic low-grade PJI. Conclusion The proposed assay appears to be a reliable and affordable tool for detecting the active MPO in synovial fluid, with promising characteristics of sensitivity and specificity in discriminating both acute and low-grade PJI from AF. Further studies are needed to confirm MPO diagnostic cut-off values and validate their use in the routine clinical practice.
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Affiliation(s)
- Martina Maritati
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Occhiobello (Rovigo), Italy
| | - Giuseppe De Rito
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Occhiobello (Rovigo), Italy
| | - Valentina Rosta
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Carlo Cervellati
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | | | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Matteo Guarino
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Anna Costanzini
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Carlo Contini
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Yu Ning
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alessandro Trentini
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
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Granata V, Strina D, Possetti V, Leone R, Valentino S, Chiappetta K, Loppini M, Mantovani A, Bottazzi B, Asselta R, Sobacchi C, Inforzato A. Interleukin-1β Polymorphisms Are Genetic Markers of Susceptibility to Periprosthetic Joint Infection in Total Hip and Knee Arthroplasty. Genes (Basel) 2024; 15:596. [PMID: 38790226 PMCID: PMC11120921 DOI: 10.3390/genes15050596] [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: 04/15/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Periprosthetic joint infections (PJIs) are serious complications of prosthetic surgery. The criteria for the diagnosis of PJI integrate clinical and laboratory findings in a complex and sometimes inconclusive workflow. Host immune factors hold potential as diagnostic biomarkers in bone and joint infections. We reported that the humoral pattern-recognition molecule long pentraxin 3 (PTX3) predicts PJI in total hip and knee arthroplasty (THA and TKA, respectively). If and how genetic variation in PTX3 and inflammatory genes that affect its expression (IL-1β, IL-6, IL-10, and IL-17A) contributes to the risk of PJI is unknown. We conducted a case-control study on a Caucasian historic cohort of THA and TKA patients who had prosthesis explant due to PJI (cases) or aseptic complications (controls). Saliva was collected from 93 subjects and used to extract DNA and genotype PTX3, IL-1β, IL-6, IL-10, and IL-17A single-nucleotide polymorphisms (SNPs). Moreover, the concentration of IL-1β, IL-10, and IL-6 was measured in synovial fluid and plasma. No association was found between PTX3 polymorphisms and PJI; however, the AGG haplotype, encompassing rs2853550, rs1143634, and rs1143627 in IL-1β, was linked to the infection (p = 0.017). Also, synovial levels of all inflammatory markers were higher in cases than in controls, and a correlation emerged between synovial concentration of PTX3 and that of IL-1β in cases only (Spearman r = 0.67, p = 0.004). We identified a relationship between rs2853550 and the synovial concentration of IL-1β and PTX3. Our findings suggest that IL-1β SNPs could be used for the early identification of THA and TKA patients with a high risk of infection.
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Affiliation(s)
- Valentina Granata
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.G.); (D.S.); (V.P.); (R.L.); (S.V.); (K.C.); (M.L.); (A.M.); (B.B.); (R.A.); (C.S.)
- Milan Unit, Institute for Genetic and Biomedical Research, National Research Council, 20138 Milan, Italy
| | - Dario Strina
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.G.); (D.S.); (V.P.); (R.L.); (S.V.); (K.C.); (M.L.); (A.M.); (B.B.); (R.A.); (C.S.)
- Milan Unit, Institute for Genetic and Biomedical Research, National Research Council, 20138 Milan, Italy
| | - Valentina Possetti
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.G.); (D.S.); (V.P.); (R.L.); (S.V.); (K.C.); (M.L.); (A.M.); (B.B.); (R.A.); (C.S.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Roberto Leone
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.G.); (D.S.); (V.P.); (R.L.); (S.V.); (K.C.); (M.L.); (A.M.); (B.B.); (R.A.); (C.S.)
| | - Sonia Valentino
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.G.); (D.S.); (V.P.); (R.L.); (S.V.); (K.C.); (M.L.); (A.M.); (B.B.); (R.A.); (C.S.)
| | - Katia Chiappetta
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.G.); (D.S.); (V.P.); (R.L.); (S.V.); (K.C.); (M.L.); (A.M.); (B.B.); (R.A.); (C.S.)
| | - Mattia Loppini
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.G.); (D.S.); (V.P.); (R.L.); (S.V.); (K.C.); (M.L.); (A.M.); (B.B.); (R.A.); (C.S.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona, Università degli Studi di Genova, 16126 Savona, Italy
| | - Alberto Mantovani
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.G.); (D.S.); (V.P.); (R.L.); (S.V.); (K.C.); (M.L.); (A.M.); (B.B.); (R.A.); (C.S.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Harvey Research Institute, Queen Mary University of London Charterhouse Square, London EC1M 6BQ, UK
| | - Barbara Bottazzi
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.G.); (D.S.); (V.P.); (R.L.); (S.V.); (K.C.); (M.L.); (A.M.); (B.B.); (R.A.); (C.S.)
| | - Rosanna Asselta
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.G.); (D.S.); (V.P.); (R.L.); (S.V.); (K.C.); (M.L.); (A.M.); (B.B.); (R.A.); (C.S.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Cristina Sobacchi
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.G.); (D.S.); (V.P.); (R.L.); (S.V.); (K.C.); (M.L.); (A.M.); (B.B.); (R.A.); (C.S.)
- Milan Unit, Institute for Genetic and Biomedical Research, National Research Council, 20138 Milan, Italy
| | - Antonio Inforzato
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy; (V.G.); (D.S.); (V.P.); (R.L.); (S.V.); (K.C.); (M.L.); (A.M.); (B.B.); (R.A.); (C.S.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
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10
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Rupp M, Walter N, Brochhausen C, Alt V. Fracture related Infection - Challenges in definition and diagnosis. J Orthop 2024; 49:38-41. [PMID: 38090606 PMCID: PMC10711025 DOI: 10.1016/j.jor.2023.11.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/19/2023] [Indexed: 03/03/2025] Open
Abstract
In the field of orthopedics and trauma surgery, the rise of periprosthetic joint infections following joint replacement and fracture-related infections (FRI) has become a growing concern. The recent establishment of a definitive definition for FRI aimed to standardize diagnosis and treatment approaches while considering unique aspects of implant-associated infections in the presence of concomitant bone fractures. Diagnosing FRI can be challenging due to the varied clinical symptoms, and confirmatory criteria may not always be evident, necessitating additional diagnostic measures. Blood markers like leukocyte count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) have limited specificity. Although novel biomarkers such as D-dimer and interleukin-6 (IL-6) show potential, they require further investigation. The use of microbiological diagnostics with tissue samples and sonication has improved pathogen detection. Cross-sectional imaging techniques like CT scans and MRI scans help evaluate bone status, soft tissue infiltration, and abscesses. Nuclear medicine techniques are accurate but may not always be practical in routine clinical practice. Histopathological interpretation for FRI remains less standardized compared to periprosthetic joint infections (PJI). FRI diagnosis requires the identification of visible microorganisms in deep tissue specimens and the quantification of polymorphonuclear neutrophils (PMNs). The defined concept of FRI has opened doors for better diagnostic and treatment approaches. However, challenges persist, especially in preoperative diagnosis, particularly for cases with unclear clinical presentations. Future endeavors aimed at optimizing diagnostic procedures and establishing a histopathological classification for FRI could lead to improved treatment recommendations and outcomes.
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Affiliation(s)
- Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Christoph Brochhausen
- Institute of Pathology, University Medical Centre Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
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11
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Sitkov N, Ryabko A, Moshnikov V, Aleshin A, Kaplun D, Zimina T. Hybrid Impedimetric Biosensors for Express Protein Markers Detection. MICROMACHINES 2024; 15:181. [PMID: 38398911 PMCID: PMC10890403 DOI: 10.3390/mi15020181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Impedimetric biosensors represent a powerful and promising tool for studying and monitoring biological processes associated with proteins and can contribute to the development of new approaches in the diagnosis and treatment of diseases. The basic principles, analytical methods, and applications of hybrid impedimetric biosensors for express protein detection in biological fluids are described. The advantages of this type of biosensors, such as simplicity and speed of operation, sensitivity and selectivity of analysis, cost-effectiveness, and an ability to be integrated into hybrid microfluidic systems, are demonstrated. Current challenges and development prospects in this area are analyzed. They include (a) the selection of materials for electrodes and formation of nanostructures on their surface; (b) the development of efficient methods for biorecognition elements' deposition on the electrodes' surface, providing the specificity and sensitivity of biosensing; (c) the reducing of nonspecific binding and interference, which could affect specificity; (d) adapting biosensors to real samples and conditions of operation; (e) expanding the range of detected proteins; and, finally, (f) the development of biosensor integration into large microanalytical system technologies. This review could be useful for researchers working in the field of impedimetric biosensors for protein detection, as well as for those interested in the application of this type of biosensor in biomedical diagnostics.
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Affiliation(s)
- Nikita Sitkov
- Department of Micro and Nanoelectronics, Saint Petersburg Electrotechnical University “LETI”, 197022 Saint Petersburg, Russia; (V.M.); (T.Z.)
- Engineering Centre for Microtechnology and Diagnostics, Saint Petersburg Electrotechnical University “LETI”, 197022 Saint Petersburg, Russia
| | - Andrey Ryabko
- Laboratory of Nonequilibrium Processes in Semiconductors, Ioffe Institute, 26 Politekhnicheskaya, 194021 Saint Petersburg, Russia;
| | - Vyacheslav Moshnikov
- Department of Micro and Nanoelectronics, Saint Petersburg Electrotechnical University “LETI”, 197022 Saint Petersburg, Russia; (V.M.); (T.Z.)
| | - Andrey Aleshin
- Laboratory of Nonequilibrium Processes in Semiconductors, Ioffe Institute, 26 Politekhnicheskaya, 194021 Saint Petersburg, Russia;
| | - Dmitry Kaplun
- Artificial Intelligence Research Institute, China University of Mining and Technology, 1 Daxue Road, Xuzhou 221116, China;
- Department of Automation and Control Processes, Saint Petersburg Electrotechnical University “LETI”, 197022 Saint Petersburg, Russia
| | - Tatiana Zimina
- Department of Micro and Nanoelectronics, Saint Petersburg Electrotechnical University “LETI”, 197022 Saint Petersburg, Russia; (V.M.); (T.Z.)
- Engineering Centre for Microtechnology and Diagnostics, Saint Petersburg Electrotechnical University “LETI”, 197022 Saint Petersburg, Russia
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