JBJI Journal of Bone and Joint Infection JBJI J. Bone Joint Infect. 2206-3552 Ivyspring Göttingen, Germany 10.7150/jbji.36015 Multiplex Antibody Measurement for Post-treatment Follow-up of Staphylococcal Prosthetic Joint Infection: A Diagnostic Pilot Study BAUER Thomas 1 MARMOR Simon 2 GHOUT Idir 3 SALOMON Elsa 4 5 SAYED Faten EL 4 5 HEYM Beate 6 ROTTMAN Martin 5 7 GAILLARD Jean-Louis 4 5 ROUX Anne-Laure 4 5 Service de Chirurgie Orthopédique et Traumatologie, Hôpital Ambroise Paré (Assistance Publique - Hôpitaux de Paris, AP-HP), Boulogne-Billancourt, France. Centre de référence des infections ostéo-articulaires, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France. Unité de Recherche Clinique Paris Île-de-France Ouest, Hôpital Ambroise Paré (AP-HP), Boulogne-Billancourt, France. Laboratoire de Microbiologie, Hôpital Ambroise Paré (AP-HP), Boulogne-Billancourt, France. UMR 1173, UFR Simone Veil, Université de Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France. Service de Microbiologie, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France. Laboratoire de Microbiologie, Hôpital Raymond Poincaré (AP-HP), Garches, France. 26 09 2019 4 5 227 233 Copyright: © 2019 Thomas BAUER et al. 2019 This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/ This article is available from https://jbji.copernicus.org/articles/4/227/2019/jbji-4-227-2019.html The full text article is available as a PDF file from https://jbji.copernicus.org/articles/4/227/2019/jbji-4-227-2019.pdf

<p class="p p-first" id="idm139834031941392"><strong>Introduction:</strong> Multiplex-antibody detection has been recently proposed for the noninvasive diagnosis of staphylococcal prosthetic joint infection (PJI). We evaluated this approach for the post-treatment follow-up of patients.</p><p id="idm139834031940656"><strong>Methods:</strong> Nineteen cases of staphylococcal PJI were prospectively followed for one year after treatment. The IgG response against eight staphylococcal antigens was measured before surgery and one year post-surgery using Luminex technology (Austin, TX, USA); median fluorescence intensity values determined for each antigen were transformed into a “Total Response Index” (TRI).</p><p id="idm139834031939744"><strong>Results:</strong> Patients (11 women/8 men) had a mean (SD) age of 72.2 (12.4) years. Site of prosthesis was the knee (n=10), the hip (n=8) and the shoulder (n=1). Ten patients were infected by <em>S. epidermidis</em>, six by <em>S. aureus</em>, and three by <em>S. lugdunensis</em>. TRI values at one year were significantly lower than pre-surgery values (mean [SD]: 5.9 [1.8] <em>versus</em> 8.1 [3.4], <em>p</em>=0.02) and decreased, on average, by 21.2%. TRI values markedly increased in two patients. One patient had a relapse of <em>S. aureus</em> PJI at five months post-surgery, with a 37% increase of the TRI. The other had septic failure three months after revision for <em>S. lugdunensis</em> PJI; all intraoperative samples remained culture-negative, but the TRI increased by 51% and the antibody profile showed a marked change, suggesting a reinfection with another staphylococcal species.</p><p class="p p-last" id="idm139834026302752"><strong>Conclusion:</strong> Multiplex-antibody measurement may be useful for the follow-up of staphylococcal PJI and may help to detect septic failure involving organisms targeted by the assay.</p>

 References Bejon P, Berendt A, Atkins BL. et al. Two-stage revision for prosthetic joint infection: predictors of outcome and the role of reimplantation microbiology. J. Antimicrob. Chemother. 2010;65:569–575. [PMC free article] Bottner F, Wegner A, Winkelmann W. et al. Interleukin-6, procalcitonin and TNF-alpha: markers of peri-prosthetic infection following total joint replacement. J. Bone Joint Surg. Br. 2007;89:94–99. Cochran AR, Ong KL, Lau E. et al. Risk of Reinfection After Treatment of Infected Total Knee Arthroplasty. J. Arthroplasty. 2016;31:156–161. Deirmengian CA, Liang L, Rosenberger JP. et al. The Leukocyte Esterase Test Strip Is a Poor Rule-Out Test for Periprosthetic Joint Infection. J. Arthroplasty. 2018;33:2571–2574. Diaz-Ledezma C, Higuera CA, Parvizi J. Success after treatment of periprosthetic joint infection: a Delphi-based international multidisciplinary consensus. Clin. Orthop. Relat. Res. 2013;471:2374–2382. [PMC free article] Frangiamore SJ, Gajewski ND, Saleh A. et al. Alpha-Defensin Accuracy to Diagnose Periprosthetic Joint Infection-Best Available Test? J Arthroplasty. 2016;31:456–460. Ghanem E, Azzam K, Seeley M. et al. Staged revision for knee arthroplasty infection: what is the role of serologic tests before reimplantation? Clin. Orthop. Relat. Res. 2009;467:1699–1705. [PMC free article] Hugle T, Schuetz P, Mueller B. et al. Serum procalcitonin for discrimination between septic and non-septic arthritis. Clin. Exp. Rheumatol. 2008;26:453–456. Kheir MM, Ackerman CT, Tan TL. et al. Leukocyte Esterase Strip Test Can Predict Subsequent Failure Following Reimplantation in Patients With Periprosthetic Joint Infection. J. Arthroplasty. 2017;32:1976–1979. Kurtz SM, Lau E, Ong K. et al. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin. Orthop. Relat. Res. 2009;467:2606–2612. [PMC free article] Kurtz SM, Ong KL, Schmier J. et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J. Bone Joint Surg. Am. 2007;89(Suppl 3):144–151. Kusuma SK, Ward J, Jacofsky M, et al.What is the role of serological testing between stages of two-stage reconstruction of the infected prosthetic knee? Clin. Orthop. Relat. Res. 2011;469:1002–1008. [PMC free article] Mankarious S, Lee M, Fischer S. et al. The half-lives of IgG subclasses and specific antibodies in patients with primary immunodeficiency who are receiving intravenously administered immunoglobulin. J. Lab. Clin. Med. 1988;112:634–640. Marmor S, Bauer T, Desplaces N. et al. Multiplex Antibody Detection for Noninvasive Genus-Level Diagnosis of Prosthetic Joint Infection. J. Clin. Microbiol. 2016;54:1065–1073. [PMC free article] Mortazavi SMJ, Vegari D, Ho A. et al. Two-stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure. Clin. Orthop. Relat. Res. 2011;469:3049–3054. [PMC free article] Osmon DR, Berbari EF, Berendt AR. et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin. Infect. Dis. 2013;56:e1–e25. Parvizi J, Della Valle CJ. AAOS Clinical Practice Guideline: diagnosis and treatment of periprosthetic joint infections of the hip and knee. J. Am. Acad. Orthop. Surg. 2010;18:771–772. Parvizi J, Zmistowski B, Berbari EF. et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin. Orthop. Relat. Res. 2011;469:2992–2994. [PMC free article] Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J. Clin. Invest. 2003;111:1805–1812. [PMC free article] Saleh A, George J, Faour M, Klika AK, Higuera CA. Serum biomarkers in periprosthetic joint infections. Bone Joint Res. 2018;7:85–93. [PMC free article] de Seynes C, de Barbeyrac B, Dutronc H. et al. Contribution of a multiplex serological test for the preoperative diagnosis of prosthetic joint infection: a prospective study. Infect. Dis. (London, England) 2018;50:609–615. Tande AJ, Patel R. Prosthetic joint infection. Clin. Microbiol. Rev. 2014;27:302–345. [PMC free article] Triantafyllopoulos GK, Memtsoudis SG, Zhang W. et al. Periprosthetic Infection Recurrence After 2-Stage Exchange Arthroplasty: Failure or Fate? J. Arthroplasty. 2017;32:526–531.