Synovial Fluid D-Lactate-A Novel Pathogen-Specific Biomarker for the Diagnosis of Periprosthetic Joint Infection

被引:23
作者
Karbysheva, Svetlana [1 ,2 ,3 ,4 ,5 ,6 ]
Yermak, Katsiaryna [1 ,2 ,3 ,4 ]
Grigoricheva, Ludmila [5 ]
Renz, Nora [1 ,2 ,3 ,4 ]
Perka, Carsten [1 ,2 ,3 ,4 ]
Trampuz, Andrej [1 ,2 ,3 ,4 ,6 ]
机构
[1] Charite Univ Med Berlin, Berlin, Germany
[2] Free Univ Berlin, Berlin, Germany
[3] Humboldt Univ, Berlin, Germany
[4] Berlin Inst Hlth, Ctr Musculoskeletal Surg CMSC, Berlin, Germany
[5] Fed Ctr Traumatol Orthoped & Arthroplasty, Barnaul, Russia
[6] Charite Univ Med Berlin, Berlin Brandenburg Sch Regenerat Therapies BSRT, Berlin, Germany
关键词
synovial fluid; D-lactate; diagnosis; periprosthetic joint infection; biomarker; D-LACTIC ACID; MULTIPLEX PCR; BACTERIAL; HIP; SONICATION; CONSENSUS;
D O I
10.1016/j.arth.2020.03.016
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Synovial fluid D-lactate may be useful for diagnosing periprosthetic joint infection (PJI) as this biomarker is exclusively produced by bacteria. We evaluated the performance of synovial fluid D-lactate using 2 definition criteria and determined its optimal cutoff value for diagnosing PJI. Methods: Consecutive patients undergoing joint aspiration before prosthesis revision were prospectively included. Synovial fluid was collected for culture, leukocyte count, and D-lactate concentration (by spectrophotometry). Youden's J statistic was used for determining optimal D-lactate cutoff value on the receiver operating characteristic curve by maximizing sensitivity and specificity. Results: A total of 224 patients were included. Using Musculoskeletal Infection Society criteria, 71 patients (32%) were diagnosed with PJI and 153 (68%) with aseptic failure (AF), whereas using institutional criteria, 92 patients (41%) were diagnosed with PJI and 132 (59%) with AF. The optimal cutoff of synovial fluid D-lactate to differentiate PJI from AF was 1.3 mmol/L, independent of the used definition criteria. Synovial fluid D-lactate had a sensitivity of 94.3% (95% confidence interval [95% CI], 86.2-98.4) and specificity of 78.4% (95% CI, 66.8-81.2) using Musculoskeletal Infection Society criteria, whereas its sensitivity was 92.4% (95% CI, 84.9-96.9) and specificity 88.6% (95% CI, 81.9-93.5) using institutional criteria. The concentration of D-lactate was higher in infections caused by Staphylococcus aureus (P < .001) and streptococci (P = .016) than by coagulase-negative staphylococci or in culture-negative PJI. Conclusion: The synovial fluid D-lactate showed high sensitivity (>90%) for diagnosis of PJI using both definition criteria and correlated with the pathogen virulence. The high sensitivity makes this biomarker useful as a point-of-care screening test for PJI. (C) 2020 Elsevier Inc. All rights reserved.
引用
收藏
页码:2223 / +
页数:9
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