Sonication in the diagnosis of fracture-related infections (FRI)-a retrospective study on 230 retrieved implants.
Sonication in the diagnosis of fracture-related infections (FRI)-a retrospective study on 230 retrieved implants.
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DOI：
10.1186/s13018-021-02460-z
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发表时间：
2021-05-13
影响因子：
2.6
通讯作者：
Baecker H
中科院分区：
文献类型：
--
作者：
Bellova P;Knop-Hammad V;Königshausen M;Schildhauer TA;Gessmann J;Baecker H
在呼吸道相关感染（FRI）中，感染的诊断和致病病原体的鉴定对于优化治疗结果至关重要。超声处理已成功用于假体周围关节感染（PJI）;然而，其在FRI中的作用仍然未知。我们的目的是确定超声液体培养（SFC）的诊断准确性（敏感性，特异性）。主要目的是使用Metsemakers等人的共识定义在总体和亚组中比较SFC与种植体周围组织培养（PTC）。次要目的是确定SFC在可能的乳房相关感染（PFRI）中的产量。回顾性分析了2017年3月至2019年5月期间230例取出的植入物。为了进行超声处理，术中将外植体置于无菌聚丙烯罐中。在超声浴（Bandelin，柏林，德国）中处理后，将超声处理液孵育到血液培养瓶中，并最终进行常规培养。使用二乘二列联表确定灵敏度和特异性。McNemar检验用于比较配对样本之间的比例，而Fisher精确检验用于比较分类变量之间的比例。在230例病例中，107例被确定为FRI，而123例为无菌翻修病例（ARC）。在后者中，105个被标记为PFRI。SFC的灵敏度高于PTC，但未达到统计学显著性（90.7% vs. 84.1%; p = 0.065）。SFC的特异性显著低于PTC（73.2% vs. 88.6%; p = .003）。在PFRI中，SFC产生的阳性结果显著高于PTC（33/105 vs. 14/105; p = .003）。总体而言，SFC鉴定出142种病原体，而PTC发现了131种病原体。我们发现，骨折固定器械的超声处理可能是FRI的一个有用的辅助手段，特别是在缺乏明确临床标准的“低度”感染中。标准化的诊断协议是必要的，以进一步优化诊断的准确性。
In fracture-related infections (FRI), both the diagnosis of the infection and the identification of the causative pathogen are crucial to optimize treatment outcomes. Sonication has been successfully used for periprosthetic joint infections (PJI); however, its role in FRI remains unknown. Our aim was to determine the diagnostic accuracy (sensitivity, specificity) of sonicate fluid culture (SFC). The primary objective was to compare SFC with peri-implant tissue culture (PTC) overall and among subgroups using the consensus definition by Metsemakers et al. The secondary objective was to determine the yield of SFC in possible fracture-related infections (PFRI). From March 2017 to May 2019, 230 cases of retrieved implants were retrospectively reviewed. To perform sonication, explants were placed in sterile polypropylene jars intraoperatively. After treatment in an ultrasonic bath (Bandelin, Berlin, Germany), sonicate fluid was incubated into blood culture bottles, and conventional culturing was eventually performed. Sensitivity and specificity were determined using two-by-two contingency tables. McNemar’s test was used to compare proportions among paired samples while Fisher’s exact test was used for comparison between categorical variables. Of the 230 cases, 107 were identified as FRI, whereas 123 were aseptic revision cases (ARC). Of the latter, 105 were labeled as PFRI. Sensitivity of SFC was higher in comparison with PTC, although this did not reach statistical significance (90.7% vs. 84.1%; p = .065). The specificity of SFC was significantly lower than that of PTC (73.2% vs. 88.6%; p = .003). In PFRI, SFC yielded significantly more positive results than PTC (33/105 vs. 14/105; p = .003). Overall, 142 pathogens were identified by SFC, whereas 131 pathogens were found by PTC. We found that sonication of fracture fixation devices may be a useful adjunct in FRI, especially in “low-grade” infections lacking confirmatory clinical criteria. Standardized diagnostic protocols are warranted in order to further optimize the diagnostic accuracy.
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影响因子：
--
作者：
Reisener M;Perka C
通讯作者：
Perka C
影响因子：
4.4
作者：
Calhoun, JH;Manring, MM
通讯作者：
Manring, MM
影响因子：
2.8
作者：
Holinka, Johannes;Bauer, Leonhard;Presterl, Elisabeth
通讯作者：
Presterl, Elisabeth
影响因子：
2.3
作者：
Metsemakers, Willem-Jan;Morgenstern, Mario;Zimmerli, Werner
通讯作者：
Zimmerli, Werner
影响因子：
2.3
作者：
Govaert, Geertje A. M.;Kuehl, Richard;Metsemakers, Willem-Jan
通讯作者：
Metsemakers, Willem-Jan