J Bone Jt Infect 2020; 5(2):89-95. doi:10.7150/jbji.42076

Research Paper

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, Stéphane Corvec1, The Centre de Référence des Infections Ostéo-articulaires du Grand Ouest (CRIOGO) Study Team

1. Bacteriology Department, CHU Nantes, Nantes Université, Nantes, France.
2. Bacteriology and Infection Control Department, CHU Nantes, Nantes Université, Nantes, France.
3. Bacteriology Department, INSERM, CHU Rennes, Rennes Université, Rennes, France.
4. Bacteriology Department, CHU Poitiers, Poitiers Université, Poitiers, France.
5. Bacteriology Department, CHU Angers, Angers Université, Angers, France.
6. Bacteriology Department, CHU Tours, Tours Université, Tours, France.
7. Bacteriology Department, CH La Roche/Yon, La Roche/Yon, France.
✉ Corresponding author: Pascale Bémer, Bacteriology Department, CHU Nantes, 5 allée de l'Ile Gloriette, 44093 Nantes Cedex 01, France. Tel. +33 2 40 08 39 85; Fax +33 2 40 08 38 29; E-mail: pascale.bemer@chu-nantes.fr.

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Citation:
Bémer P, Bourigault C, Jolivet-Gougeon A, Plouzeau-Jayle C, Lemarie C, Chenouard R, Valentin AS, Bourdon S, Leroy AG, Corvec S, The Centre de Référence des Infections Ostéo-articulaires du Grand Ouest (CRIOGO) Study Team. Assessment of a Multiplex Serological Test for the Diagnosis of Prosthetic Joint Infection: a Prospective Multicentre Study. J Bone Jt Infect 2020; 5(2):89-95. doi:10.7150/jbji.42076. Available from http://www.jbji.net/v05p0089.htm

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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.

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