Current Recommendations for the Diagnosis of Acute and Chronic PJI for Hip and Knee-Cell Counts, Alpha-Defensin, Leukocyte Esterase, Next-generation Sequencing
Current Recommendations for the Diagnosis of Acute and Chronic PJI for Hip and Knee-Cell Counts, Alpha-Defensin, Leukocyte Esterase, Next-generation Sequencing
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DOI：
10.1007/s12178-018-9513-0
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发表时间：
2018-09-01
影响因子：
4.1
通讯作者：
Courtney, P. Maxwell
中科院分区：
文献类型：
--
作者：
Goswami, Karan;Parvizi, Javad;Courtney, P. Maxwell
尽管近年来取得了重大进展，但假体周围关节感染（PJI）的诊断仍然是一个挑战，没有金标准测试存在。血清学、滑膜学、微生物学、组织学和放射学检查相结合进行，这些检查费用昂贵，通常是侵入性的，而且不完善。近年来，新的生物标志物和分子方法显示出前景。本综述的目的是提供关于PJI诊断建议的最新信息，并涵盖一些新兴的诊断工具。最近的文献强调了一种新的基于证据的诊断髋关节和膝关节PJI的定义，该定义在正式的外部多机构验证中表现出色。也有越来越多的证据支持血清和滑液中选定的生物标志物的测量，如α -防御素、d -二聚体和白细胞介素-6。最后，讨论了新一代测序在病原体鉴定中的应用。总之，我们描述了目前诊断PJI的建议和新出现的检测方法。讨论了残差分析的局限性和今后的研究方向。
Despite significant progress in recent years, the diagnosis of periprosthetic joint infection (PJI) remains a challenge and no gold standard test exists. A combination of serological, synovial, microbiological, histological, and radiological investigations is performed that are expensive, often invasive, and imperfect. Novel biomarkers and molecular methods have shown promise in recent years. The purpose of this review is to provide an update about the diagnostic recommendations for PJI and cover a selection of emerging diagnostic tools.Recent literature highlights a new evidence-based definition for diagnosing hip and knee PJI that shows excellent performance on formal external multi-institutional validation. There is also increasing evidence to support the measurement of selected biomarkers in serum and synovial fluid, such as alpha-defensin, D-dimer, and interleukin-6. Finally, the emerging utility of next-generation sequencing for pathogen identification is discussed.In summary, we describe current recommendations and emerging tests for the diagnosis of PJI. Residual limitations and directions for future research are also discussed.