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Diagnosis of Spinal Infection with Alpha-defensin Lateral Flow Test: A Preliminary Report
Atsuhiro Yoshida1,2, Tsutomu Akazawa1,2, Yoshiaki Torii1,2
1Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Introduction:
The alpha-defensin lateral flow test has been used in periprosthetic joint infection as a diagnostic support tool because of its simplicity and speed. However, the test has not been used to diagnose spinal infections. The purpose of this study was to investigate the efficacy of the alpha-defensin lateral flow test for diagnosing spinal infections.
Methods:
The subjects were 11 patients who were suspected of having spinal infections from October 2019 to August 2021 and underwent biopsies at a single institution. There were nine male and two female patients, with an average age of 60.7 (14-87) years. For diagnosing infection, the patient's consent for biopsy was obtained, and the sample was collected by computed tomography-guided aspiration biopsy or open biopsy at the site considered to be a possible abscess. The samples were subjected to a bacterial culture test, an acid-fast bacillus culture test, and an alpha-defensin lateral flow test (SynovasureⓇ lateral flow test; Zimmer Biomet, IN, USA).
Results:
Of the 11 suspected spinal infections, the alpha-defensin lateral flow test was positive in 8 cases, negative in 2 cases, and undeterminable in 1 case. Of the 10 cases excluding the undeterminable case, the definitive diagnosis was 9 cases of spinal infection (spondylitis: 6 cases, spinal implant infection: 3 cases) and 1 case of vertebral body fracture. The alpha-defensin lateral flow test demonstrated a sensitivity of 88.9%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 50%. The biopsy sample culture test demonstrated a sensitivity of 77.8%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 33.3%.
Conclusions:
We suggested that the alpha-defensin lateral flow test might be useful as a diagnostic support tool for spinal infections.
Insights
The alpha-defensin lateral flow test shows promise for diagnosing spinal infections, demonstrating high sensitivity and specificity. This rapid test could aid clinicians in identifying infections, complementing traditional methods.
Area of Science:
- Orthopedics
- Infectious Diseases
- Diagnostic Medicine
Background:
- Alpha-defensin lateral flow tests are established for periprosthetic joint infections.
- Their utility in diagnosing spinal infections remains largely unexplored.
- Spinal infections require timely and accurate diagnosis for effective treatment.
Purpose of the Study:
- To evaluate the efficacy of the alpha-defensin lateral flow test in diagnosing spinal infections.
- To compare its diagnostic performance against traditional biopsy and culture methods.
Main Methods:
- Eleven patients with suspected spinal infections underwent biopsy.
- Samples were tested using bacterial culture, acid-fast bacillus culture, and the alpha-defensin lateral flow test.
- Diagnostic performance metrics including sensitivity, specificity, and predictive values were calculated.
Main Results:
- The alpha-defensin test yielded 8 positive, 2 negative, and 1 undeterminable result out of 11 suspected cases.
- Excluding the undeterminable case, the test showed 88.9% sensitivity and 100% specificity for spinal infection.
- Compared to biopsy culture (77.8% sensitivity), the alpha-defensin test demonstrated superior sensitivity.
Conclusions:
- The alpha-defensin lateral flow test shows potential as a valuable diagnostic support tool for spinal infections.
- Its high accuracy suggests it can aid in the rapid identification of spinal infections.
- Further research may validate its role in clinical practice for spinal infection diagnostics.
