Interleukin-6 and other inflammatory markers in diagnosis of periprosthetic joint infection (PJI) 4 th International Conference/Orthopedics & Rheumatology.

Slides:



Advertisements
Similar presentations
Surgical Site Infection Improvement Programme Surveillance: Case studies.
Advertisements

Tad Kim, M.D. Connie Lee, M.D. Michael Hong, M.D. Kenny DeSart, M.D.
Cerebrospinal fluid Culture + Body Fluid Culture.
Infection After ACL Reconstruction H. Makhmalbaf MD Consultant Orth.& Knee Surgeon Mashhad University of Medical Sciences.
Erythrocyte sedimentation rate (ESR) is a non-specific test for inflammation. It is easy to perform, widely available, Inexpensive making it a widely.
Sputum Culture بسم الله الرحمن الرحيم
Procalcitonin Over the past two decades, the body of literature on the clinical usefulness of procalcitonin (PCT) in adults has grown rapidly. Although.
“Diagnostic value of procalcitonin in well appearing young febrile infants” Pediatrics 2012; 130:
Review of Frozen Section Results and correlation with microbiology for revision joint replacement surgery Dr R Hadden BSc MBBS SpR Histopathology Derriford.
MLAB 2434 – CLINICAL MICROBIOLOGY SUMMER, 2005 CECILE SANDERS & KERI BROPHY Chapter 7 – General Concepts in Specimen Collection and Handling.
Postoperative Fever.
Blood Culture. Bacteremia: Types  Transient: Disruption of mucosal surfaces (dental or surgical procedures)  Intermittent: Associated with abscesses.
Management of Infections About Total Knee Arthroplasty Frank Ebert, M.D. Union Memorial Hospital Baltimore, MD.
V. Petrenkiene*, D. Petrauskas L. Kupcinskas, Lithuanian University of Health sciences Clinic of Gastroenterology Kaunas Utility of non-invasive markers.
Your hospitals, your health, our priority MICROBIOLOGY OF PROSTHETIC JOINT INFECTIONS Dr Robert Nelson.
Wound infections.
Level of Evidence: Level II Clin Orthop Relat Res 2008 Journal meeting Summarized R4 黃贊文 Supervised Dr. 沈世勛 Diagnosis of Infected Total Knee.
Microbiologic Surrogates: An Industry Perspective Barry Eisenstein, MD Senior Vice President, Research and Development Cubist Pharmaceuticals Clinical.
Microbiology Nuts & Bolts Test Yourself – Skin & Bone Begin here.
Comparison of the Diagnostic Value of the Standard Tube Agglutination Test and the ELISA IgG and IgM in Patients with Brucellosis Presented by Dr. Md.
C-Reactive Protein: a Prognosis Factor for Septic Patients Systematic Review and Meta-analysis Introduction to Medicine – 1 st Semester Class 4, First.
Approach to Acute Monoarthritis of the Knee
Microbiological Evaluation of PJIs Survey Results Lorenzo Drago IRCCS Galeazzi Institute – University of Milan.
Septic Arthritis Pamela Gregory-Fernandez, PA-C SVCMC PA Education Program.
Clinical Microbiology ( MLCM- 201) Prof. Dr. Ebtisam.F. El Ghazzawi. Medical Research Institute (MRI) Alexandria University.
Carlos Pineda Roger Kerr. Roger Kerr, Los Angeles, CA 49 year old male with 6 month history of wrist pain and swelling. Past medical history.
Dr. Nancy Cornish Director of Microbiology Methodist and Children’s Hospitals CUTANEOUS INFECTIONS.
Khalil Allah. Nazem Feb  In the face of an increasing prevalence of TKA, intensified efforts at infection prevention seem logical to reduce the.
MEDICAL TESTING Doctor requires information Patient sample collection
Pyogenic Bone and Joint Infection Abdulaziz Al-Ahaideb FRCSC.
Management of Infections About Total Hip Arthroplasty Frank Ebert, M.D. Union Memorial Hospital Baltimore, MD.
SSI: I hear the words, but are we talking about the same thing? Safer Healthcare Now! Western Node Wendy Runge, RN, BScN, CIC Infection Prevention and.
Serum procalcitonin and C-reactive protein in children with community- acquired pneumonia K.Gogvadze, I.Guramishvili, I.Chkhaidze, K.Nemsadze, T.Maglakelidze.
Differential Diagnosis. Staphylococcus aureus Mycobacterium marinum.
Assuring Data Quality Dept. of Healthcare-Associated Infection & Antimicrobial Resistance, Health Protection Agency Jennie Wilson Programme Leader – SSI.
Bone & Joints Infections. Osteomyelitis Osteomyelitis is infection of the bone. Infections can reach a bone by traveling through the bloodstream, spreading.
Can Urine Clarity Exclude the Diagnosis of Urinary Tract Infection? Date: 2002/6/28 黃錦鳳 / 黃玉純.
Randomized Trial of Ea rly S urgery Versus Conventional Treatment for Infective E ndocarditis (EASE) Duk-Hyun Kang, MD, PhD on behalf of The EASE Trial.
MLAB 2434 – MICROBIOLOGY KERI BROPHY-MARTINEZ Microscopic Examination of Infected Materials.
Quality Control in Microbiology - 1 5%-30% of positive blood cultures represent contamination with skin To keep numbers of contaminants.
Serum Levels of Glycosaminoglycans (GAGs) and Insulin Like Growth Factor-1 (IGF-1) as New Diagnostic Markers for Hepatocellular Carcinoma. Ahmad S. Ibrahim*,
Osteomyelitis defined as inflammation of bone and bone marrow, it is virtually synonymous with infection. can be secondary to systemic infection but more.
Copyright restrictions may apply JAMA Pediatrics Journal Club Slides: Procalcitonin Use to Predict Bacterial Infection in Febrile Infants Milcent K, Faesch.
Ischaemic Heart Disease CASE A. CASE A: Mr HA, aged 60 years, was brought in to A&E complaining of chest pain, nausea and a suspected AMI.
Mini BAL v/s Bronchoscopic BAL PROF. PRADYUT WAGHRAY MD (CHEST), DTCD, FCCP (USA),D.SC(PULM. MEDICINE) HEAD OF DEPT. OF PULMONARY MEDICINE S.V.S MEDICAL.
Journal club Diagnostic accuracy of Urinalysis for UTI in Infants
C - reactive protein. C - reactive protein ( CRP ) ◌ C-reactive protein was originally discovered as a substance in the serum of patients with acute inflammation.
BioPlex 2200 HIV Ag-Ab Assay
Revision Hip Replacement Richard Boden Consultant Trauma and Lower Limb Orthopaedic Surgeon (locum) Lancashire Teaching Hospitals NHS Foundation Trust.
DIAGNOSIS OF SEPTIC JOINT IN CHILDREN Sara Jane Shippee UW Orthopaedic Surgery, PGY-1 Seattle Children’s Hospital 11/1/2012.
ANA Testing Carrie Marshall 1/18/08. Septic Arthritis RRC R heumatology R esearch C enter.
Laparoscopic supracervical hysterectomy and total laparoscopic hysterectomy: A comparison of peri- operative outcomes Dr Kate Maclaran, Mr Nilesh Agarwal,
Epidemiology, general characteristics and clinical evolution
Serum chronicity markers as surrogate measures of frailty
GUIDELINES FOR PROSTHETIC JOINT INFECTION CID 2013
No conflict of interest
PRESURE ULCER Pressure ulcers cause pain, decrease quality of life, and lead to significant morbidity and prolonged hospital stays, in part due to complicating.
EVALUATION OF SOLUBLE CD14 SUBTYPE (PRESEPSIN)
The Value of Measurement of Circulating Tumor Cells in Hepatocellular Carcinoma Nashwa Sheble, Gehan Hamdy, Moones A Obada, Gamal Y Abouria, Fatma Khalaf.
Ochsner Health System- Orthopedics Division Research Studies
Menachem M Meller,MD, PhD
ADEIGA.A, AWODERU O.A,FANEYE.A, AKINTUNDE, GB, ONYEWUCHE.J.
Management of Infection and Periprosthetic Fracture in TKR
OBTAINING WOUND CULTURES
Sputum Culture بسم الله الرحمن الرحيم
Cerebrospinal fluid Culture
Supervised by Dr Tim Bracey
Cerebrospinal fluid Culture
Pleural, peritoneal, pericardial & synovial fluids culture
Presentation transcript:

Interleukin-6 and other inflammatory markers in diagnosis of periprosthetic joint infection (PJI) 4 th International Conference/Orthopedics & Rheumatology Baltimore, Maryland, USA October 27 th, 2015 Adham Elsharkawi Elgeidi, MD Abdelrahman Elganainy, MD Noha Abou Elkhier, MD Shirien Rakha, MD Mansoura, EGYPT

No Conflict of interest

BackgroundBackground Aim of the studyAim of the study Patients & MethodsPatients & Methods - Criteria for definitive diagnosis of PJI - Criteria for definitive diagnosis of PJI ResultsResults DiscussionDiscussion - Limitations - Limitations ConclusionsConclusions

Background

PJI is one of most common indications for PJI is one of most common indications for revision hip and knee arthroplasties. revision hip and knee arthroplasties. In revision arthroplasty, distinction bet In revision arthroplasty, distinction bet septic and aseptic failure is critical → septic and aseptic failure is critical → Rx of failure secondary to PJI is different. Rx of failure secondary to PJI is different. Background

Several serum inflammatory markers → Dx of Several serum inflammatory markers → Dx of suspected PJI. suspected PJI. IL-6 is a cytokine produced by activated IL-6 is a cytokine produced by activated macrophages, monocytes and T cells in macrophages, monocytes and T cells in context of inflammatory response. context of inflammatory response. IL-6 as a dx marker is still under investigation IL-6 as a dx marker is still under investigation & is not used routinely. & is not used routinely. Background

Validate usefulness of IL-6 & other inflammatory markers (CRP, ESR, and WCC) in dx of PJI Aim of the study

Patients and methods

40 hip / knee replacement Patients for 40 hip / knee replacement Patients for 2-stage revision surgery ( ). 2-stage revision surgery ( ). 21 ♂ & 19♀. 21 ♂ & 19♀. Age: 38–72 years (58.4 years ). Age: 38–72 years (58.4 years ). No arthroplasty was sonicated. No arthroplasty was sonicated. Prospective study

Exclusion criteria 1.Chronic inflam. conditions (e.g. RA). 2.Malignancy. 3.Antibiotic Rx prior to surgery.

Blood samples obtained within 2 hrs before surgery. Blood samples obtained within 2 hrs before surgery. Collected into two separate tubes. Collected into two separate tubes. One: a serum separator tested for CRP and IL-6. One: a serum separator tested for CRP and IL-6. The other : with sodium citrate for ESR and WCC. The other : with sodium citrate for ESR and WCC. Blood test

Intra-op 6 deep tissue samples collected for: 1.Histopathological evaluation (formalin preserved, paraffin embedded sections). 2. Conventional microbiologic culture (sterile surgical container ). Tissue Samples

Definitive Diagnosis of PJI (1) Visible purulence surrounding prosthesis. (2) Sinus tract communicating to implant. (3) Growth of bacteria on culture: a- ≥ 2 cultures that yield same organism. a- ≥ 2 cultures that yield same organism. b- 1 culture with a virulent microorganism b- 1 culture with a virulent microorganism (e.g. Staph aureus). (e.g. Staph aureus). (4) Histopathological Examination: a- acute inflammation (≥ 5 PMN / HPF) a- acute inflammation (≥ 5 PMN / HPF) b. combined with a positive culture. b. combined with a positive culture.

Results

Results 40 patients.40 patients. 11 (27.5 %): proved to be infected (PJI).11 (27.5 %): proved to be infected (PJI). 29 (72.5 %): aseptic failure of prosthesis.29 (72.5 %): aseptic failure of prosthesis.

Results Isolated bacteria included:Isolated bacteria included: 1.Gram positive cocci: a.staphy aureus (n=5) a.staphy aureus (n=5) b.coagulase-negative staph (n=3) b.coagulase-negative staph (n=3) c.enterococci (n=1) c.enterococci (n=1) 2.Gram negative bacilli: a.escherichia coli (n=1) a.escherichia coli (n=1) b.pseudomonas aeuroginosa (n=1) b.pseudomonas aeuroginosa (n=1)

Table 1: Demographic data for the study population Characteristic Infected (n=11) Aseptic (n=29) Age (years) 59.6± ±7.8 Gender Male 4 (36.4 %) 17 (58.6 %) Male 4 (36.4 %) 17 (58.6 %) Female 7 (63.6 %) 12 (41.4 %) Female 7 (63.6 %) 12 (41.4 %) Joint type Knee 4 (36.4 %) 10 (34.5 %) Knee 4 (36.4 %) 10 (34.5 %) Hip 7 (63.6 %) 19 (65.5 %) Hip 7 (63.6 %) 19 (65.5 %) Variables are expressed as mean ± SD, or numbers (percentage)

Table 2: Analysis of inflammatory markers in patients with infected and aseptic revision arthroplasty Inflammatory marker All procedures (hip+knee) Infected Aseptic P value Infected Aseptic P value ESR (mm/hour) Mean SD WCC (cell×10 9L) Mean SD CRP (mg/L) Mean SD IL-6 (pg/L) Mean SD

Table 3: sensitivity, specificity, PPV, NPV, & accuracy of inflammatory markers Test Cut-off Sensit (%) Specif (%) PPV (%) NPV (%) Accuracy (%) ESR (mm/hour) CRP (mg/L) WCC (cell/ 10 9 /L ) IL-6 (pg/mL) IL-6 + CRP

Discussion

Dx of PJI remains a real challenge. Dx of PJI remains a real challenge. Standard lab used as first line tests to determine PJI Standard lab used as first line tests to determine PJI ie ESR,WCC, and CRP, are not consistently reliable. ie ESR,WCC, and CRP, are not consistently reliable. Cultures of wound drainage and sinus tracts do not Cultures of wound drainage and sinus tracts do not truly reflect organisms deep in joint, due to truly reflect organisms deep in joint, due to likelihood of contamination by other skin flora. likelihood of contamination by other skin flora. Joint aspirate is useful for determining deep Joint aspirate is useful for determining deep infection. Sometimes, it cannot be easily obtained or infection. Sometimes, it cannot be easily obtained or enough fluid is aspirated. enough fluid is aspirated. Discussion

In this study, we evaluated utility of pre-op ESR, In this study, we evaluated utility of pre-op ESR, WCC, serum CRP, and IL-6 as markers for PJI. WCC, serum CRP, and IL-6 as markers for PJI. ESR has little value in diagnosis of PJI since its ESR has little value in diagnosis of PJI since its sensitivity (81.8%) and specificity(82.8%) are low. sensitivity (81.8%) and specificity(82.8%) are low. WCC sensitivity of 90.9 % and specificity of 75.9 % WCC sensitivity of 90.9 % and specificity of 75.9 % IL-6 sensitivity (100 %) is similar to CRP, its IL-6 sensitivity (100 %) is similar to CRP, its specificity (90.9 vs 86.2 %) and accuracy (92.5 vs specificity (90.9 vs 86.2 %) and accuracy (92.5 vs 87.5 %) are higher %) are higher. Discussion

Advantage of IL-6: exhibits more rapid ↑and quicker ↓ to Advantage of IL-6: exhibits more rapid ↑and quicker ↓ to normal vs CRP or ESR which are ↑ up to 3 wks post-op. normal vs CRP or ESR which are ↑ up to 3 wks post-op. IL-6 level is a superior indicator of post-op. inflam. response IL-6 level is a superior indicator of post-op. inflam. response and to monitor infected patient’s response to Rx (1-3). and to monitor infected patient’s response to Rx (1-3). 1.Odak S, McNicholas M (2012) Diagnosis and management of infection after total knee arthroplasty. Orthop Trauma 26(2):80–85 2.Bottner F, Wegner A, Winkelmann W, Becker K, Erren M, Gotze C (2007) Interleukin- 6, procalcitonin, TNF-α markers of periprosthetic infection following total joint replacement. J Bone Joint Surg Br 89-B:94–99 3.Wirtz DC, Heller KD, Miltner O, Zilkens KW, Wolff JM (2000) Interleukin-6: a potential inflammatory marker after total joint replacement. Int Orthop 24:194–196 Discussion

Limitations 1.Small number of included patients: 40 patients. 1.Not serially monitor IL-6 & markers post-op. 2.Intra-op. tissue samples chosen is not infected.

Conclusions

Conclusions IL-6 is reliable marker for PJI, as it disting. between patients with infection and aseptic failure of prosthesis.IL-6 is reliable marker for PJI, as it disting. between patients with infection and aseptic failure of prosthesis. IL-6 >10.4 pg/ml and CRP >18 mg/L → identify all patients with PJIIL-6 >10.4 pg/ml and CRP >18 mg/L → identify all patients with PJI (sensitivity 100 %, NPV 100 %). (sensitivity 100 %, NPV 100 %). CRP + IL-6 is an excellent screening test to rapidly rule out deep infection of the implant.CRP + IL-6 is an excellent screening test to rapidly rule out deep infection of the implant.

ﺍﻠﻧﻯ ﺮﺑﻛﻣ ﺃﻋﺑﺪﻮﺍ ﻟﻧﺎﺱ ﺍ ﻴﺄﻴﻬﺎ ﻗﺑﻟﻛﻣ ﻣﻦ ﻴﻦ ﻮﺍﻠﻧ ﺧﻟﻗﻛﻣ ﺗﺗﻗﻮﻦ ﻠﻌﻠﻛﻣ (٢۰ ﺍﻟﺑﻗﺮﺓ ) O mankind! Worship your lord (Allah) who created you and those before you so that you may become Al-Muttaqun (the pious and righteous persons who fear Allah much and love Allah much, ( The Noble Qur`an, The Cow,20) بسم الله الرحمن الرحيم In the name of Allah, In the name of Allah, the Beneficent, the Merciful Thank You Mansoura, EGYPT 2015