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Can we rely on histopathological results for the diagnosis of prosthetic joint infection?
C Fourcade1, A Gomez-Brouchet2, A Bouige3
1Infectious Disease Mobile Unit, Hôpital Joseph Ducuing, 15 rue Varsovie, 31300 Toulouse, France.
Background:
Histopathology is one of the diagnostic criteria for prosthetic joint infection (PJI) proposed by all academic societies. The aim of this study was to compare histopathological and microbiological results from samples taken intraoperatively at the same site in patients with suspected or proven PJI.
Patients And Methods:
We conducted a monocenter retrospective study including all patients having undergone surgery from 2007 to 2015 with suspected or proven PJI. During surgery, both histopathological and microbiological samples were taken. Patients with a history of antimicrobial treatment 2 weeks prior to surgery were excluded. We considered as major criteria and gold standard for PJI diagnosis the presence of a sinus tract communication and/or the same microorganism in at least two cultures.
Results:
Finally, 181 patients who underwent 309 surgeries were included. The median number of samples per surgery was 4 (interquartile range (IQR) = 3-5) for histopathology and 5 (IQR = 4-6) for microbiology. Major criteria were observed in 177 patients (57.3%), while positive histology in at least one intraoperative sample was present in 119 (38.5%). The concordance was 74%. The sensitivity and specificity of histopathology were 61% and 92% respectively. Available "histopathology-culture" sample pairs numbered 1247. Among them, positive histopathology was found in 292 samples (23%) and culture in 563 (45%). Concordance was 64%. The highest correlation was observed for very early infection (<1 month) (OR: 9.1, 95% CI: 3.6-23) and for virulent microorganisms, such as Staphylococcus aureus (OR: 7.8, 95% CI: 5.2-11.8), Streptococci (OR:7.8; 95% CI: 4-15.2) or Enterobacterales (OR: 7.4; 95% CI: 4.2-13.1).
Conclusion:
Histopathologic examination is a valuable criterion for PJI diagnosis, but it may lack sensitivity for chronic infections or due to low-virulence pathogens.
Insights
Histopathology is a valuable tool for diagnosing prosthetic joint infection (PJI), showing high specificity. However, its sensitivity can be limited in chronic cases or with less virulent bacteria.
Area of Science:
- Orthopedics
- Infectious Diseases
- Pathology
Background:
- Prosthetic joint infection (PJI) diagnosis relies on histopathology, a criterion supported by academic societies.
- This study aimed to compare histopathological and microbiological findings from intraoperative samples in PJI cases.
Purpose of the Study:
- To evaluate the diagnostic accuracy of histopathology in comparison to microbiological cultures for prosthetic joint infection (PJI).
- To assess the concordance and correlation between histopathological and microbiological results from intraoperative samples.
Main Methods:
- A retrospective monocenter study included 181 patients undergoing 309 surgeries for suspected or proven PJI between 2007 and 2015.
- Intraoperative histopathological and microbiological samples were collected simultaneously; patients with recent antimicrobial treatment were excluded.
- PJI diagnosis was based on major criteria including sinus tract communication or identical microorganisms in multiple cultures.
Main Results:
- Histopathology showed a sensitivity of 61% and specificity of 92% for PJI diagnosis.
- Overall concordance between histopathology and microbiology was 74% for major criteria and 64% for individual sample pairs.
- Histopathology demonstrated higher correlation with PJI in early infections (<1 month) and with virulent microorganisms like Staphylococcus aureus.
Conclusions:
- Histopathologic examination is a valuable diagnostic criterion for PJI.
- Its sensitivity may be reduced in chronic infections or when caused by low-virulence pathogens.
- Combined histopathological and microbiological analysis may offer a more comprehensive diagnostic approach.
