Membrane Filtration of Sonication Fluid—A Promising Adjunctive Method for the Diagnosis of Low-Grade Infection in Presumed Aseptic Nonunion

IF 2.1 3区 医学 Q2 ORTHOPEDICS
Katharina Trenkwalder, Sandra Erichsen, Ferdinand Weisemann, Peter Augat, SAND Research Group, Simon Hackl
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Abstract

Treatment guidelines for fracture nonunion differ based on the presence or absence of infection. Low-grade infections without preoperative clinical signs of infection are difficult to distinguish from aseptic cases. Membrane filtration of sonication fluid (MF) has been shown to be a useful method for identifying septic nonunion. Therefore, the aim of this study was to evaluate the diagnostic value of MF in differentiating low-grade infected nonunion from aseptic cases. A prospective multicenter clinical study enrolled 75 patients with femoral or tibial shaft nonunion with planned revision surgery and without clinical suspicion of infection. During revision surgery, tissue from the nonunion zone was sampled for culture and histopathology, and the implant for sonication with MF and colony forming unit (CFU) quantification. Infection was diagnosed according to the diagnostic criteria for fracture-related infection. The diagnostic performance of MF CFU count was evaluated by receiver operating characteristic (ROC) curve and compared with that of tissue culture (TC), sonication fluid broth culture (SFC), and Histopathological Osteomyelitis Evaluation Score (HOES). Fifty-three nonunion cases were aseptic, and 22 had a low-grade infection. ROC curve had an area under the curve of 0.84. The optimal CFU cutoff to discriminate between low-grade infected and aseptic nonunion was 11.1 CFU/10 mL sonication fluid with 64% sensitivity and 89% specificity. SFC showed a higher sensitivity of 82% but a lower specificity of 81%. The sensitivity and specificity of TC were 77% and 96%, respectively, and those of HOES were 9% and 87%, respectively. Implementation of MF in clinical diagnostics as an adjunct to TC may improve the differential diagnosis between low-grade infected nonunion and aseptic nonunion.

Abstract Image

超声液膜过滤-一种有前途的辅助诊断无菌性骨不连低级别感染的方法
骨折不愈合的治疗指南根据有无感染而有所不同。术前无感染临床体征的低级别感染很难与无菌病例区分。超声液膜过滤(MF)已被证明是一种有效的方法,以确定脓毒性骨不连。因此,本研究的目的是评估MF在鉴别低级别感染骨不连和无菌性骨不连中的诊断价值。一项前瞻性多中心临床研究纳入了75例计划翻修手术且无临床感染怀疑的股骨或胫骨骨不连患者。在翻修手术期间,从不愈合区取样组织进行培养和组织病理学检查,并对植入物进行超声检查,用MF和菌落形成单位(CFU)定量。按照骨折相关感染诊断标准诊断感染。采用受试者工作特征(ROC)曲线评价MF CFU计数的诊断价值,并与组织培养(TC)、超声液汤培养(SFC)和组织病理学骨髓炎评估评分(HOES)进行比较。53例骨不连为无菌性,22例为低度感染。ROC曲线下面积为0.84。鉴别低级别感染和无菌性骨不连的最佳CFU临界值为11.1 CFU/10 mL超声液,敏感性64%,特异性89%。SFC的敏感性为82%,特异性较低,为81%。TC的敏感性和特异性分别为77%和96%,HOES的敏感性和特异性分别为9%和87%。在临床诊断中应用MF作为TC的辅助手段,可以提高低级别感染性骨不连和无菌性骨不连的鉴别诊断。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Orthopaedic Research®
Journal of Orthopaedic Research® 医学-整形外科
CiteScore
6.10
自引率
3.60%
发文量
261
审稿时长
3-6 weeks
期刊介绍: The Journal of Orthopaedic Research is the forum for the rapid publication of high quality reports of new information on the full spectrum of orthopaedic research, including life sciences, engineering, translational, and clinical studies.
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