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Commercial Synovial Antibody Testing is No Better Than Traditional Culture in Identification of Pathogen(s) Causing
Marcelo Siqueira1, Emanuele Chisari1, Steven Yacovelli1
1Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA.
Background:
Identification of infective organism causing periprosthetic joint infections (PJIs) is crucial to tailor the best combination of surgical and antimicrobial treatment. Traditional culture, with all its limitations, has been utilized for this purpose. A synovial fluid antibody assay against some common pathogens has been introduced by a commercial entity recently. This study aimed to determine if the antibody testing could be used as a proxy to traditional culture, and whether it provided additional information, in the setting of PJI.
Methods:
A retrospective study was conducted of patients who underwent revision total hip and knee arthroplasty between January 2019 and 2020. Aspirated synovial fluid was sent for analyses including the commercial antibody testing. All patients had samples harvested for culture per standard of care. Results of the antibody testing and culture, in terms of concordance, were compared. Receiver operating characteristic curve and Youden's criterion were used to compare the 2 methods.
Results:
A total of 419 patients were included. Using the International Consensus Meeting criteria as reference standard for PJI, antibody testing had a sensitivity and specificity of 40.5% and 93.4%, respectively. There were 59.5% false negative results with antibody testing compared with 50% for culture. Of the 12 patients who had positive results in both tests, 5 (41.7%) had discordant pathogens identified in each test.
Conclusion:
Synovial fluid antibody testing does not provide clinical benefit when compared to traditional cultures for PJI diagnosis. The antibody testing had a low sensitivity and a high rate of discordance with culture, when both tests were positive.
Insights
Synovial fluid antibody testing for periprosthetic joint infections (PJIs) showed low sensitivity and high discordance with traditional cultures. This new method offers no clinical benefit over established culture methods for diagnosing PJIs.
Area of Science:
- Orthopedics
- Infectious Diseases
- Medical Diagnostics
Background:
- Accurate identification of causative pathogens in periprosthetic joint infections (PJIs) is essential for effective treatment.
- Traditional culture methods, despite limitations, are the standard for pathogen detection in PJIs.
- A novel synovial fluid antibody assay has emerged as a potential diagnostic tool.
Purpose of the Study:
- To evaluate the utility of a commercial synovial fluid antibody assay in diagnosing PJIs.
- To compare the diagnostic performance of antibody testing against traditional culture methods.
- To determine if antibody testing provides additional clinical information for PJI management.
Main Methods:
- A retrospective study of 419 patients undergoing revision hip and knee arthroplasty.
- Synovial fluid samples were analyzed using both commercial antibody testing and standard culture.
- Diagnostic performance was assessed using International Consensus Meeting criteria, receiver operating characteristic curves, and Youden's criterion.
Main Results:
- Antibody testing demonstrated a sensitivity of 40.5% and specificity of 93.4% for PJI diagnosis.
- False negative rates were higher for antibody testing (59.5%) compared to culture (50%).
- Significant discordance was observed when both tests yielded positive results, with only 41.7% agreement on identified pathogens.
Conclusions:
- Synovial fluid antibody testing does not offer a clinical advantage over traditional cultures for PJI diagnosis.
- The low sensitivity and high discordance rate limit the reliability of antibody testing in PJI cases.
- Current antibody testing methods are not recommended as a substitute for conventional cultures in PJI diagnosis.
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