Leukocyte Esterase Strip Test Can Predict Subsequent Failure Following Reimplantation in Patients With Periprosthetic Joint Infection

被引:38
作者
Kheir, Michael M. [1 ]
Ackerman, Colin T. [1 ]
Tan, Timothy L. [1 ]
Benazzo, Andrea [1 ]
Tischler, Eric H. [1 ]
Parvizi, Javad [1 ]
机构
[1] Thomas Jefferson Univ, Rothman Inst, Philadelphia, PA 19107 USA
关键词
leukocyte esterase; periprosthetic joint infection; reimplantation; hip; knee; diagnostic test; TOTAL KNEE ARTHROPLASTY; REAGENT STRIPS; RAPID DIAGNOSIS; 2-STAGE REIMPLANTATION; SYNOVIAL-FLUID; URINE DIPSTICK;
D O I
10.1016/j.arth.2017.01.031
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: 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. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:1976 / 1979
页数:4
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