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Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
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Volume 5, issue 2
J. Bone Joint Infect., 5, 89–95, 2020
© Author(s) 2020. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 5, 89–95, 2020
© Author(s) 2020. This work is distributed under
the Creative Commons Attribution 4.0 License.

Original full-length article 30 Mar 2020

Original full-length article | 30 Mar 2020

Assessment of a Multiplex Serological Test for the Diagnosis of Prosthetic Joint Infection: a Prospective Multicentre Study

Pascale Bémer1, Céline Bourigault2, Anne Jolivet-Gougeon3, Chloé Plouzeau-Jayle4, Carole Lemarie5, Rachel Chenouard5, Anne-Sophie Valentin6, Sandra Bourdon7, Anne-Gaëlle Leroy1, and Stéphane Corvec1 Pascale Bémer et al.
  • 1Bacteriology Department, CHU Nantes, Nantes Université, Nantes, France.
  • 2Bacteriology and Infection Control Department, CHU Nantes, Nantes Université, Nantes, France.
  • 3Bacteriology Department, INSERM, CHU Rennes, Rennes Université, Rennes, France.
  • 4Bacteriology Department, CHU Poitiers, Poitiers Université, Poitiers, France.
  • 5Bacteriology Department, CHU Angers, Angers Université, Angers, France.
  • 6Bacteriology Department, CHU Tours, Tours Université, Tours, France.
  • 7Bacteriology Department, CH La Roche/Yon, La Roche/Yon, France.

Keywords: prosthetic joint infection, serological diagnosis, anti-staphylococcal antibodies, sensitivity, specificity, negative predictive value

Abstract. Introduction: The diagnosis of prosthetic joint infections (PJIs) can be difficult in the chronic stage and is based on clinical and paraclinical evidence. A minimally invasive serological test against the main pathogens encountered during PJI would distinguish PJI from mechanical loosening.

Methods: We performed a prospective, multicentre, cross-sectional study to assess the contribution of serology in the diagnosis of PJI. Over a 2-year period, all patients undergoing prosthesis revision were included in the study. A C-reactive protein assay and a serological test specifically designed against 5 bacterial species (Staphylococcus aureus, S. epidermidis, S. lugdunensis, Streptococcus agalactiae, Cutibacterium acnes) were performed preoperatively. Five samples per patient were taken intraoperatively during surgery. The diagnosis of PJI was based on clinical and bacteriological criteria according to guidelines.

Results: Between November 2015 and November 2017, 115 patients were included, 49 for a chronic PJI and 66 for a mechanical problem. Among patients with PJI, a sinus tract was observed in 32.6% and a C-reactive protein level ≥10 mg/L in 74.5%. The PJI was monomicrobial in 43 cases (targeted staphylococci, 24; S. agalactiae, 1; C. acnes, 2; others, 16), and polymicrobial in 6 cases (12.2%). Sensitivity, specificity, positive predictive value and negative predictive value were 75.0%, 82.1%, 58.3% and 90.8%, respectively, for targeted staphylococci. Specificity/negative predictive value was 97.3%/100% for S. agalactiae and 83.8% /96.9% for C. acnes.

Conclusions: The serological tests are insufficient to affirm the diagnosis of PJI for the targeted bacteria. Nevertheless, the excellent NPV may help clinicians to exclude PJI.

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