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Alpha-defensin lateral flow test does not appear to be useful in predicting shoulder periprosthetic joint infections

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Abstract

Purpose

Periprosthetic joint infections (PJIs) remain a challenging complication after shoulder arthroplasty. The antimicrobial peptide α-defensin has been proposed as a new synovial fluid biomarker in diagnosing PJIs. To date, only little data are available on the diagnostic accuracy of α-defensin in shoulder PJIs; thus, we aimed to evaluate its diagnostic value in a cohort of patients with a suspected shoulder PJI.

Methods

Between June 2016 and June 2018, we prospectively enrolled patients with a diagnostic shoulder aspiration due to painful shoulder arthroplasty or planned revision surgery. PJI diagnostics were performed according to the Musculoskeletal Infection Society (MSIS) criteria. All patients with an antibiotic therapy within two  weeks before enrollment, insufficient amount of synovial aspirate, or bloody aspiration were excluded. α-Defensin was measured in the synovial fluid using the α-defensin lateral flow (ADLF) test (Synovasure®).

Results

Out of 60 patients, we could include 29 (59% female) patients with a mean age of 70 (range, 50–92) years. A shoulder PJI was detected in five cases (Staphylococcus aureus, n = 2; Staphylococcus epidermidis, n = 2; Cutibacterium acnes, n = 1). The ADLF test was positive in seven out of 29 cases. According to the MSIS criteria, the ADLF test was false-negative in two patients and false-positive in four patients, resulting in sensitivity, specificity, and positive and negative predictive value of 60%, 83%, 43%, and 91%, respectively. The overall accuracy was 79%.

Conclusion

The ALDF test does not appear to be useful in predicting shoulder PJIs but may be used as an additional diagnostic factor in rejecting these infections.

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References

  1. Zmistowski B, Karam JA, Durinka JB et al (2013) Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am 95:2177–2184. https://doi.org/10.2106/JBJS.L.00789

    Article  PubMed  Google Scholar 

  2. Kurtz SM, Lau E, Watson H et al (2012) Economic burden of periprosthetic joint infection in the United States. J Arthroplast 27:61–65.e1. https://doi.org/10.1016/j.arth.2012.02.022

    Article  Google Scholar 

  3. Fink B, Sevelda F (2017, 2017) Periprosthetic joint infection of shoulder arthroplasties: diagnostic and treatment options. Biomed Res Int. https://doi.org/10.1155/2017/4582756

    Article  CAS  Google Scholar 

  4. Achermann Y, Sahin F, Schwyzer HK et al (2013) Characteristics and outcome of 16 periprosthetic shoulder joint infections. Infection 41:613–620. https://doi.org/10.1007/s15010-012-0360-4

    Article  PubMed  CAS  Google Scholar 

  5. Klatte TO, Junghans K, Al-Khateeb H et al (2013) Single-stage revision for peri-prosthetic shoulder infection. Bone Joint J 95-B:391–395. https://doi.org/10.1302/0301-620x.95b3.30134

    Article  PubMed  CAS  Google Scholar 

  6. Foruria AM, Fox TJ, Sperling JW, Cofield RH (2013) Clinical meaning of unexpected positive cultures (UPC) in revision shoulder arthroplasty. J Shoulder Elb Surg 22:620–627. https://doi.org/10.1016/j.jse.2012.07.017

    Article  Google Scholar 

  7. Osmon DR, Berbari EF, Berendt AR et al (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the infectious diseases Society of America. Clin Infect Dis 56:1–25. https://doi.org/10.1093/cid/cis803

    Article  PubMed  Google Scholar 

  8. Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint Infection (2014) Definition of periprosthetic joint infection. J Arthroplast 29:1331. https://doi.org/10.1016/j.arth.2014.03.009

    Article  Google Scholar 

  9. Goswami K, Parvizi J, Maxwell Courtney P (2018) Current recommendations for the diagnosis of acute and chronic PJI for hip and knee—cell counts, alpha-defensin, leukocyte esterase, next-generation sequencing. Curr Rev Musculoskelet Med 11:428–438. https://doi.org/10.1007/s12178-018-9513-0

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ganz T, Selsted ME, Szklarek D et al (1985) Defensins. Natural peptide antibiotics of human neutrophils. J Clin Invest 76:1427–35. https://doi.org/10.1172/JCI112120

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Jacovides CL, Parvizi J, Adeli B, Jung KA (2011) Molecular markers for diagnosis of periprosthetic joint infection. J Arthroplast 26:99–103.e1. https://doi.org/10.1016/j.arth.2011.03.025

    Article  Google Scholar 

  12. Deirmengian C, Kardos K, Kilmartin P et al (2015) The alpha-defensin test for periprosthetic joint infection responds to a wide spectrum of organisms. Clin Orthop Relat Res 473:2229–2235. https://doi.org/10.1007/s11999-015-4152-x

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kelly MP, Darrith B, Hannon CP et al (2018) Synovial fluid alpha-defensin is an adjunctive tool in the equivocal diagnosis of periprosthetic joint infection. J Arthroplast 33:3537–3540. https://doi.org/10.1016/j.arth.2018.06.026

    Article  Google Scholar 

  14. Bingham J, Clarke H, Spangehl M et al (2014) The alpha defensin-1 biomarker assay can be used to evaluate the potentially infected total joint arthroplasty. Clin Orthop Relat Res 472:4006–4009. https://doi.org/10.1007/s11999-014-3900-7

    Article  PubMed  PubMed Central  Google Scholar 

  15. Deirmengian C, Kardos K, Kilmartin P et al (2014) Diagnosing periprosthetic joint infection: has the era of the biomarker arrived? Clin Orthop Relat Res 472:3254–3262. https://doi.org/10.1007/s11999-014-3543-8

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bonanzinga T, Zahar A, Dütsch M et al (2017) How reliable is the alpha-defensin immunoassay test for diagnosing periprosthetic joint infection? A prospective study. Clin Orthop Relat Res 475:408–415. https://doi.org/10.1007/s11999-016-4906-0

    Article  PubMed  Google Scholar 

  17. Deirmengian C, Kardos K, Kilmartin P et al (2014) Combined measurement of synovial fluid α-defensin and C-reactive protein levels: highly accurate for diagnosing periprosthetic joint infection. J Bone Joint Surg Am 96:1439–1445. https://doi.org/10.2106/JBJS.M.01316

    Article  PubMed  Google Scholar 

  18. Frangiamore SJ, Gajewski ND, Saleh A et al (2016) α-Defensin accuracy to diagnose periprosthetic joint infection-best available test? J Arthroplast 31:456–460. https://doi.org/10.1016/j.arth.2015.09.035

    Article  Google Scholar 

  19. Gehrke T, Lausmann C, Citak M et al (2018) The accuracy of the alpha defensin lateral flow device for diagnosis of periprosthetic joint infection. J Bone Joint Surg 100:42–48. https://doi.org/10.2106/JBJS.16.01522

    Article  PubMed  Google Scholar 

  20. Frangiamore SJ, Saleh A, Grosso MJ et al (2015) α-Defensin as a predictor of periprosthetic shoulder infection. J Shoulder Elb Surg 24:1021–1027. https://doi.org/10.1016/j.jse.2014.12.021

    Article  Google Scholar 

  21. Unter Ecker N, Koniker A, Gehrke T et al (2019) What is the diagnostic accuracy of alpha-defensin and leukocyte esterase test in periprosthetic shoulder infection? Clin Orthop Relat Res 477:1712–1718. https://doi.org/10.1097/CORR.0000000000000762

    Article  PubMed  PubMed Central  Google Scholar 

  22. Balato G, Franceschini V, Ascione T et al (2018) High performance of α-defensin lateral flow assay (Synovasure) in the diagnosis of chronic knee prosthetic infections. Knee Surg Sports Traumatol Arthrosc 26:1717–1722. https://doi.org/10.1007/s00167-017-4745-x

    Article  PubMed  Google Scholar 

  23. Berger P, Van Cauter M, Driesen R et al (2017) Diagnosis of prosthetic joint infection with alpha-defensin using a lateral flow device. Bone Joint J 99-B:1176–1182. https://doi.org/10.1302/0301-620X.99B9.BJJ-2016-1345.R2

    Article  PubMed  CAS  Google Scholar 

  24. Kasparek MF, Kasparek M, Boettner F et al (2016) Intraoperative diagnosis of periprosthetic joint infection using a novel alpha-defensin lateral flow assay. J Arthroplast 31:2871–2874. https://doi.org/10.1016/j.arth.2016.05.033

    Article  Google Scholar 

  25. Suda AJ, Tinelli M, Beisemann ND et al (2017) Diagnosis of periprosthetic joint infection using alpha-defensin test or multiplex-PCR: ideal diagnostic test still not found. Int Orthop 41:1307–1313. https://doi.org/10.1007/s00264-017-3412-7

    Article  PubMed  Google Scholar 

  26. Stone WZ, Gray CF, Parvataneni HK et al (2018) Clinical evaluation of synovial alpha defensin and synovial C-reactive protein in the diagnosis of periprosthetic joint infection. J Bone Jt Surg 100:1184–1190. https://doi.org/10.2106/JBJS.17.00556

    Article  Google Scholar 

  27. Plate A, Stadler L, Sutter R et al (2018) Inflammatory disorders mimicking periprosthetic joint infections may result in false-positive α-defensin. Clin Microbiol Infect 24:1212.e1–1212.e6. https://doi.org/10.1016/j.cmi.2018.02.019

    Article  CAS  Google Scholar 

  28. Riccio G, Cavagnaro L, Akkouche W et al (2018) Qualitative alpha-defensin versus the main available tests for the diagnosis of periprosthetic joint infection: best predictor test? J Bone Joint Infect 3:156–164. https://doi.org/10.7150/jbji.26401

    Article  Google Scholar 

  29. De Vecchi E, Romanò CL, De Grandi R et al (2018) Alpha defensin, leukocyte esterase, C-reactive protein, and leukocyte count in synovial fluid for pre-operative diagnosis of periprosthetic infection. Int J Immunopathol Pharmacol 32:205873841880607. https://doi.org/10.1177/2058738418806072

    Article  CAS  Google Scholar 

  30. Grosso MJ, Frangiamore SJ, Saleh A et al (2014) Poor utility of serum interleukin-6 levels to predict indolent periprosthetic shoulder infections. J Shoulder Elb Surg 23:1277–1281. https://doi.org/10.1016/j.jse.2013.12.023

    Article  Google Scholar 

  31. Piper KE, Fernandez-Sampedro M, Steckelberg KE et al (2010) C-reactive protein, erythrocyte sedimentation rate and orthopedic implant infection. PLoS One 5:4–9. https://doi.org/10.1371/journal.pone.0009358

    Article  CAS  Google Scholar 

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Acknowledgments

We would like to acknowledge and thank all the members of the shoulder team at the University Hospital Balgrist who contributed to the inclusion of the study participants.

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Author notes

    Authors and Affiliations

    1. Department of Orthopedics Surgery , University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

      Lizzy Weigelt, Dario Frustaci, Patrick O. Zingg & Christian Gerber

    2. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

      Andreas Plate, Laura Stadler & Yvonne Achermann

    3. Department of Radiology, University Hospital Balgrist, University of Zurich, Zurich, Switzerland

      Reto Sutter

    4. Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland

      Reinhard Zbinden

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    1. Lizzy Weigelt
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    Corresponding author

    Correspondence to Lizzy Weigelt.

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    Conflict of interest

    This study was an investigator-initiated trial, and only the Synovasure® tests were provided by the company Zimmer Biomet (Synovasure®, Zimmer Biomet, Winterthur, Switzerland).

    Informed consent

    Informed consent was obtained from all individual participants included in the study.

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    The Cantonal Ethics Committee Zurich (KEK Zürich) approved the study. (BASEC Number: 2016–00145).

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    There are no financial biases for any author. The company had no influence of the study design, in- and exclusion of patients, and study results.

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    Weigelt, L., Plate, A., Stadler, L. et al. Alpha-defensin lateral flow test does not appear to be useful in predicting shoulder periprosthetic joint infections. International Orthopaedics (SICOT) 44, 1023–1029 (2020). https://doi.org/10.1007/s00264-020-04532-x

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