Journal of Bone and Joint Infection最新文献

{"title":"Implementation of a novel process for post-discharge microbiology results review for musculoskeletal infections in a large-volume academic healthcare system.","authors":"Margaret Pertzborn, Amy L Van Abel, Trudi Lane, Kristin Cole, Douglas Osmon, Diana J Schreier, Hilary Teaford, Courtney M Willis, Anna Woods, Raymund R Razonable, Abinash Virk, Christina G Rivera","doi":"10.5194/jbji-10-447-2025","DOIUrl":"10.5194/jbji-10-447-2025","url":null,"abstract":"<p><p>Awaiting final microbiology results can delay discharge in musculoskeletal (MSK) infections. We developed a novel process based on electronic medical records reviewing post-discharge results. Among 1662 encounters, 35.6 % had <math><mo>≥</mo></math> 1 intervention, often therapy modification. Multidisciplinary review by an orthopaedic infectious diseases team improved antimicrobial optimization through timely action on culture results after discharge.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 6","pages":"447-450"},"PeriodicalIF":2.8,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12628069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid pathogen detection in synovial fluid of acute native joint infections in adults: a clinical evaluation of a novel automated multiplex polymerase chain reaction (mPCR) system.","authors":"Lukas Rabitsch, Markus Luger, Felix Lötsch, Peter Starzengruber, Florian Thalhammer, Reinhard Windhager, Birgit Willinger, Irene Katharina Sigmund","doi":"10.5194/jbji-10-437-2025","DOIUrl":"10.5194/jbji-10-437-2025","url":null,"abstract":"<p><p><b>Aim</b>: The aim of this study was to investigate the diagnostic performance of a novel rapid multiplex polymerase chain reaction (mPCR) in adults with suspected acute native joint infection. <b>Methods</b>: This retrospective single-centre study included 143 patients with suspected acute native joint infection from February 2023 to May 2024. A septic arthritis was classified based on institutional criteria. The agreement between mPCR and conventional culture of synovial fluid (SF) was assessed by calculating the Cohen's <math><mi>κ</mi></math> coefficient. The diagnostic performance of mPCR was calculated, and the area under the curve (AUC) was compared with conventional culture of synovial fluid by using the <math><mi>z</mi></math> test. <b>Results</b>: When considering only microorganisms targeted by mPCR, this method detected 13 novel microorganisms in 13 cases compared to conventional culture, resulting in an overall agreement of 91 %, a positive agreement of 100 %, a negative agreement of 88 %, and a Cohen's <math><mi>κ</mi></math>  coefficient of 0.780. Of these 13 cases, 9 were classified as septic, with 6 ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>6</mn> <mo>/</mo> <mn>9</mn></mrow> </math> , 67 %) on antibiotics prior to aspiration. When considering all microorganisms (including off-panel microorganisms), the overall percentage agreement between mPCR and conventional culture was 89 %, with a Cohen's <math><mi>κ</mi></math>  coefficient of 0.735, indicating substantial agreement. Sensitivity, specificity, PPV, NPV, LR <math><mo>+</mo></math> , LR <math><mo>-</mo></math> , accuracy, and AUC of mPCR were 45 %, 89 %, 90 %, 44 %, 4.21, 0.62, 59 %, and 0.671, and those of conventional culture were 40 %, 100 %, 100 %, 45 %, 0.60, 59 %, and 0.698. No difference in performance was observed between both methods ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.183</mn></mrow> </math> ). The combination of both techniques showed a sensitivity, specificity, PPV, NPV, LR <math><mo>+</mo></math> , LR <math><mo>-</mo></math> , accuracy, and AUC of 48 %, 89 %, 90 %, 46 %, 4.5, 0.58, 62 %, and 0.686. <b>Conclusion</b>: Given its comparable diagnostic performance and faster turnaround time relative to conventional synovial fluid culture, this novel mPCR can be recommended as a valuable adjunct in the diagnosis of septic arthritis in adults, particularly in patients with prior antimicrobial treatment.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 6","pages":"437-446"},"PeriodicalIF":2.8,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12607419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infective endocarditis meets native vertebral osteomyelitis: a mortality perspective.","authors":"Fabio Borgonovo, Francesco Petri, Takahiro Matsuo, Rita Igwilo-Alaneme, Seyed Mohammad Amin Alavi, Omar K Mahmoud, Said El Zein, Matteo Passerini, Mohammad Hassan Murad, Daniel C DeSimone, Ahmad Nassr, Aaron J Tande, Andrea Gori, Elie F Berbari","doi":"10.5194/jbji-10-425-2025","DOIUrl":"10.5194/jbji-10-425-2025","url":null,"abstract":"<p><p><b>Background</b>: Native vertebral osteomyelitis and infective endocarditis (NVO <math><mo>+</mo></math> IE) are increasingly recognized as overlapping entities, sharing common risk factors (e.g., advanced age, immunosuppression) and similar pathogen profiles, most commonly <i>Staphylococcus aureus</i> and streptococci. Concurrent infection presents unique diagnostic and therapeutic challenges, leading to uncertainty regarding clinical outcomes and mortality. Therefore, we aimed to systematically evaluate the combined mortality associated with concomitant NVO <math><mo>+</mo></math> IE and to summarize the available clinical characteristics from published studies. <b>Methods</b>: A systematic review was conducted following the PRISMA framework. The databases searched included MEDLINE, Embase, Cochrane Library, and Scopus from 1970 to October 2023. Studies were included if they involved at least 10 adult patients diagnosed with NVO and IE and provided mortality data. Two reviewers independently screened the references, extracted the data, and evaluated the methodological quality using a dedicated tool. A random-effects meta-analysis was performed to aggregate in-hospital, 1-month, 1-year, and 3-year mortality rates. <b>Results</b>: A total of 16 studies (12 retrospective, 3 prospective, 1 mixed) were included, involving 641 patients (mean age 67.1 years) with NVO <math><mo>+</mo></math> IE. In-hospital mortality was 14.0 % (95 % CI: 10.0 %-20.0 %). At 1 month, mortality was 9.0 % (95 % CI: 5.0 %-17.0 %), rising to 18.0 % (95 % CI: 13.0 %-24.0 %) by 1 year and 16.0 % (95 % CI: 3.0 %-50.0 %) by 3 years. Significant between-study heterogeneity was observed ( <math> <mrow><msup><mi>I</mi> <mn>2</mn></msup> </mrow> </math>  range: 3 %-70 %). Common co-morbidities included diabetes mellitus (23.7 %), chronic renal failure (15.0 %), and immunosuppression (15.0 %). Streptococci (31.5 %), <i>S. aureus</i> (25.2 %), and enterococci (17.7 %) were the primary pathogens. Cardiac valve surgery and spinal surgery were reported in 47.5 % and 29.9 % of patients, respectively. A subgroup analysis on 1-month mortality showed that <i>S. aureus</i> predominance was associated with a significantly higher mortality compared to streptococci. Certainty in the estimates was low due to imprecision and methodological limitations. <b>Conclusions</b>: Concomitant NVO <math><mo>+</mo></math> IE is associated with substantial mortality, especially for <i>S. aureus</i>, underscoring the need for earlier diagnosis, coordinated multidisciplinary management, and standardized treatment protocols. Future prospective, high-quality studies are needed to clarify optimal strategies for diagnostic workup and surgical intervention for this complex clinical scenario.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 6","pages":"425-435"},"PeriodicalIF":2.8,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12606593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete talectomy for post-traumatic osteomyelitis (and/or avascular necrosis): report of a new technique.","authors":"Daniel Pérez-Prieto, Alois Baumer, Jan Martinez-Lozano, Julian Aquilina, Paul Zamora, Albert Alier, Lluïsa Sorlí","doi":"10.5194/jbji-10-419-2025","DOIUrl":"10.5194/jbji-10-419-2025","url":null,"abstract":"<p><p>The main complications after complex talar fractures, especially with respect to open injuries, are avascular necrosis (AVN) and fracture-related infection (FRI) Their treatment is a source of discussion, and reconstruction options are scarce. A descriptive longitudinal study of three cases with a two-stage tibiocalcaneal (TC) arthrodesis (talectomy followed by a retrograde nailing and two tantalum spacers) is presented. Information on infection relapse and fusion of the arthrodesis was collected, along with demographic, radiological, and functional variables (such as Manchester-Oxford Foot Questionnaire, MOXFQ, values; EuroQol index values; and visual analogue scale for pain, VAS-pain, values) After a minimum of 3 years, no infection relapse or pseudoarthrosis was observed. Leg alignment was comparable to the contralateral side. Functional and pain tests showed optimal values: MOXFQ index of 16.6, mean EuroQol index of 0.782, and mean VAS-pain of 19. For a salvage procedure in FRI <math><mo>+</mo></math> AVN of the talus, this two-stage TC arthrodesis is a safe procedure in terms of infection and provides good functional outcomes.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 6","pages":"419-424"},"PeriodicalIF":2.8,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12606459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic value of magnetic resonance imaging and the outcomes of medical therapy in histologically confirmed diabetes-related foot osteomyelitis.","authors":"Abhay Mishra, Paige Lyell, David M Bamberger","doi":"10.5194/jbji-10-411-2025","DOIUrl":"10.5194/jbji-10-411-2025","url":null,"abstract":"<p><p><b>Background</b>: The preferred imaging modality in diabetes-related foot osteomyelitis is magnetic resonance imaging; however the test characteristics of magnetic resonance imaging have not been well evaluated in histologically confirmed disease. Although there is reasonably strong evidence of the effectiveness of medical therapy in the treatment of diabetes-related foot osteomyelitis, there is limited evidence in histologically confirmed cases. <b>Methods</b>: A retrospective review of episodes in which diabetes-related foot osteomyelitis was suspected was performed among patients who had both magnetic resonance imaging and bone histology. Magnetic resonance images were reviewed by a musculoskeletal trained radiologist using guideline criteria. Cases were subsequently followed for need for amputation at 1 year. <b>Results</b>: Among 84 episodes, the sensitivity of magnetic resonance imaging in histologically confirmed diabetes-related foot osteomyelitis was 96 %, specificity 38.2 %, positive predictive value 69.6 %, negative predictive value 86.7 %, positive likelihood ratio 1.15, and negative likelihood ratio 0.1. Of 15 cases in which the histology specimen revealed osteomyelitis from a diagnostic biopsy, 10 responded to medical management without the need for an amputation. <b>Conclusions</b>: Magnetic resonance imaging is useful excluding diabetes-related foot osteomyelitis but is of limited diagnostic value in confirming its presence. Most cases of histologically confirmed diabetes-related foot osteomyelitis responded to medical management without the need for amputation.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 5","pages":"411-417"},"PeriodicalIF":2.8,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12607418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are KLIC and CRIME-80 scores useful to assist decision-making initially or at the moment of repeat DAIR? - a retrospective study.","authors":"Joana Contente, Carlos Ferreira, Mário Silva, Guilherme Madeira, Ana Ribau, Ricardo Sousa","doi":"10.5194/jbji-10-403-2025","DOIUrl":"10.5194/jbji-10-403-2025","url":null,"abstract":"<p><p><b>Introduction</b>: Debridement, antibiotics, and implant retention (DAIR) is recommended for early acute postoperative and late acute periprosthetic joint infections (PJIs). The KLIC and CRIME-80 scores have been proposed to predict DAIR outcomes. Nevertheless, their clinical utility remains uncertain. This study aimed to evaluate their predictive value for DAIR failure in our cohort, both at primary indication and when repeat DAIR was considered necessary. <b>Methods</b>: We retrospectively reviewed all patients who underwent DAIR for total hip or knee PJI between 2010 and 2021, with at least 1 year of follow-up. Failure was defined as persistent infection, need for implant removal, amputation, or infection-related death. <b>Results</b>: A total of 102 patients were included, with a mean follow-up of 48.9 months. The overall failure rate was 35.3 %. Failure rates did not differ significantly between patients who underwent a single DAIR and those who required repeat procedures (32.5 % vs. 45.5 %, <math><mrow><mi>p</mi> <mspace></mspace> <mo>=</mo></mrow> </math>  0.26). No significant correlations were found between KLIC or CRIME-80 scores and failure rates, either at the initial indication for DAIR ( <math><mrow><mi>p</mi> <mspace></mspace> <mo>=</mo></mrow> </math>  0.54 and <math><mrow><mi>p</mi> <mspace></mspace> <mo>=</mo></mrow> </math>  0.93, respectively) or in repeat DAIR procedures ( <math><mrow><mi>p</mi> <mspace></mspace> <mo>=</mo></mrow> </math>  0.44 and <math><mrow><mi>p</mi> <mspace></mspace> <mo>=</mo></mrow> </math>  0.50, respectively). <b>Conclusions</b>: In our cohort, the KLIC and CRIME-80 scores were not predictive of DAIR failure, either at initial treatment or when repeat DAIR was required. These scores offered limited prognostic value and did not support clinical decision-making. Prospective studies are needed to validate and improve predictive tools for DAIR outcomes.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 5","pages":"403-410"},"PeriodicalIF":2.8,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12604571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical practice variation in orthopedic infections: insights from the Musculoskeletal Infection Society (MSIS) and European Bone and Joint Infection Society (EBJIS) survey, 2023.","authors":"Laura K Certain, Irene K Sigmund","doi":"10.5194/jbji-10-397-2025","DOIUrl":"10.5194/jbji-10-397-2025","url":null,"abstract":"<p><p>In 2023, members of the Musculoskeletal Infection Society (MSIS) and the European Bone and Joint Infection Society (EBJIS) participated in a survey assessing their approaches to prevention, diagnosis, and management of orthopedic infections. The survey revealed notable differences between the two societies in several key areas, including requirements for smoking cessation prior to elective surgery, use of pre-operative skin and nasal antiseptics, application of local antibiotics in non-infected cases, preferred definitions of periprosthetic joint infection (PJI), use of alpha-defensin testing in pre-operative diagnosis, application of sonication of explanted implants, number of tissue samples obtained for microbiological and histological analysis, use of sequence-based diagnostics, and duration of antibiotic therapy. These findings demonstrate substantial variability in clinical practice among international experts in the field, highlighting the need for further research and consensus to harmonize strategies in orthopedic infection care.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 5","pages":"397-402"},"PeriodicalIF":2.8,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12604139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical approaches in total hip arthroplasty do not influence the bacterial spectrum of acute postoperative periprosthetic joint infections.","authors":"Jonas Tumler, Dominic Simon, Gautier Beckers, Alexander C Paulus, Boris M Holzapfel, Jörg Arnholdt","doi":"10.5194/jbji-10-385-2025","DOIUrl":"10.5194/jbji-10-385-2025","url":null,"abstract":"<p><p><b>Introduction</b>: With the increasing number of primary total hip arthroplasties (THAs), the incidence of associated complications has risen, with periprosthetic joint infection (PJI) being among the most severe. The influence of surgical approach on infection risk remains debated; however, its effect on the microbiological profile of PJIs is not well examined. This study aimed to evaluate whether the primary surgical approach affects the spectrum of microorganisms involved in acute postoperative periprosthetic hip joint infections in a retrospective single-center cohort. <b>Methods</b>: A total of 76 patients who underwent revision surgery for PJI following THA between January 2013 and June 2024 were retrospectively reviewed. After applying exclusion criteria, patients were categorized based on the initial surgical approach: lateral vs. direct anterior/anterolateral. The microbiological spectrum was compared between groups using Fisher's exact test. Demographic characteristics and their associations with surgical approach and pathogen type were also analyzed. <b>Results</b>: No significant differences were found in the microbiological spectrum between surgical approaches. Similarly, there was no significant correlation between surgical approach and the occurrence of Gram-positive or Gram-negative organisms. Body mass index (BMI) was not associated with variations in pathogen distribution, suggesting that obesity does not influence the microbiological profile of PJI. <b>Discussion</b>: These findings suggest that the microbiological characteristics of acute postoperative PJI are independent of the primary surgical approach. Minimally invasive anterior techniques do not appear to carry an increased microbiological risk. Additionally, BMI does not influence the microbial spectrum of infection. <b>Level of evidence</b>: this is a retrospectively registered cohort study with a Level III level of evidence.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 5","pages":"385-396"},"PeriodicalIF":2.8,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12604140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of chronic osteomyelitis between 2016 and 2022 in a large, multicenter database in the United States.","authors":"Rawabi Aljadani, Hyunkeun Cho, Martha L Carvour","doi":"10.5194/jbji-10-377-2025","DOIUrl":"10.5194/jbji-10-377-2025","url":null,"abstract":"<p><p><b>Introduction</b>: Chronic osteomyelitis (COM) is a serious musculoskeletal infection that affects a patient's quality of life and long-term survival. In this study, we assessed overall, regional, and patient-level characteristics of bacterial COM in a large, multicenter database in the United States. <b>Methods</b>: We used ICD-10 codes to identify incident bacterial COM in the TriNetX database between 1 January 2016 and 31 December 2022. We calculated COM incidence per 1000 adult patients with the associated 95 % confidence intervals. We used the Cochran-Armitage test to assess incidence trends across the study period. <b>Results</b>: A total of 93 324 adult patients were identified. Overall, a steady COM incidence was observed over time, with some indication of lower rates starting in 2020. The incidence was about 2-fold higher in males than females. As expected, lower-extremity COM was most common overall and among males. Although lower-extremity COM and vertebral COM had comparable incidence among females, vertebral COM became slightly more common than lower-extremity COM among females during the study period. <b>Conclusions</b>: To our knowledge, this study provides the largest available, multicenter estimate of COM incidence in the United States. Although the incidence of COM was generally steady over time, a slight reduction was noted during the pandemic (2020 and later). This finding may reflect important differences in ascertainment or competing risks during that period.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 5","pages":"377-384"},"PeriodicalIF":2.8,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12598500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum inflammatory markers for the screening and diagnosis of periprosthetic joint infection: a systematic review and meta-analysis.","authors":"Irene K Sigmund, Matthew J Dietz, Marta Sabater-Martos, Antony J R Palmer, Nicolas Cortés-Penfield","doi":"10.5194/jbji-10-363-2025","DOIUrl":"10.5194/jbji-10-363-2025","url":null,"abstract":"<p><p><b>Aim</b>: As part of a multi-society effort to derive a unified consensus definition of periprosthetic joint infection (PJI), a systematic review of serum inflammatory marker diagnostic performance for hip, knee, and shoulder PJI was performed. <b>Methods</b>: PubMed (MEDLINE) and EMBASE were searched for studies reporting the diagnostic performance of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), fibrinogen, interleukin-6 (IL-6), or D-dimer for PJI. From these, each markers' pooled sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and area under the summary receiver operating characteristic curve (AUSROC) were calculated using a random-effects model. <b>Results</b>: A total of 89 studies reported all diagnostic performance measures for at least one marker. CRP (84 studies, 22 351 patients) demonstrated a pooled sensitivity, specificity, PPV, NPV, and AUSROC of 79.4 % (95 %CI: 78.5-80.3), 77.7 % (77.1-78.3), 67.0 % (63.3-70.7), 86.6 % (84.5-88.7), and 0.872 (SE 0.01), respectively. Corresponding performance estimates for fibrinogen (14 studies, 3433 patients) were 70.9 % (68.3-73.3), 85.9 % (84.3-87.3), 77.2 % (71.8-82.6), 82.1 % (77.1-87.2), and 0.889 (0.02), respectively, and those for IL-6 (20 studies, 2318 patients) were 76.3 % (73.4-79.0), 85.8 % (83.8-87.6), 74.5 % (69.0-80.0), 86.0 % (80.6-91.3), and 0.900 (0.01), respectively. ESR, D-dimer, and WBC did not offer greater predictive values than these markers. <b>Conclusion</b>: Although serum CRP, fibrinogen, and IL-6 demonstrated the best performance among all analysed parameters, their diagnostic accuracy remains insufficient to reliably confirm or exclude PJI. Elevated serum markers should be re-evaluated as a diagnostic criterion in future PJI definitions. <b>Level of evidence</b>: The level of evidence was Level III.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 5","pages":"363-376"},"PeriodicalIF":2.8,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12604141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145504495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}