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首页> 美国卫生研究院文献>Experimental and Therapeutic Medicine >Limitations of Gram staining for the diagnosis of infections following total hip or knee arthroplasty
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Limitations of Gram staining for the diagnosis of infections following total hip or knee arthroplasty

机译：革兰氏染色在全髋或膝关节置换术后感染诊断中的局限性

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摘要

The diagnosis of prosthetic joint infection (PJI) following total joint arthroplasty is difficult for clinicians to make decisions due to the similar symptoms presented by aseptic loosening and infection. Gram staining (GS) is a widely used test but its value remains controversial due to conflicting results in the diagnosis of PJI. The aim of the present study was therefore to evaluate the value of GS in the diagnosis of PJI. Searches using MEDLINE, EMBASE and OVID databases were conducted for data published between January 1990 and December 2013. Meta-analysis was used to pool the sensitivity, specificity, diagnostic odd ratios (DORs), area under the receiver-operating characteristic curve (AUC), positive-likelihood ratios (PLRs), negative-likelihood ratios (NLRs) and post-test probability. The heterogeneity and publication bias were assessed, and subgroup and meta-regression analyses were conducted. A total of 18 studies, including a total of 4,647 patients, were selected for analysis. The pooled sensitivity and specificity values for the diagnosis of PJI were 0.19 and 1.00, respectively. The AUC, PLR and NLR were 0.89, 41.6 and 0.82, respectively. Subgroup analyses indicated that the sensitivity/specificity for total hip arthroplasty was 0.14/0.99, whereas that for total knee arthroplasty was 0.14/1.00. Synovial fluid best reflected accurate GS-based diagnoses, with the highest DOR of 242, whereas tissue had the highest AUC of 0.96 (95% CI, 0.94–0.97). GS had a poor clinically acceptable diagnostic value for detecting PJI. These data do not support the routine use of GS, without additional proof of infection, for diagnosing PJI; instead, GS could be used as an adjuvant tool to support the results of other investigations.
机译：由于无菌性松动和感染所表现出的相似症状，全关节置换术后的假体关节感染（PJI）的诊断对于临床医生来说很难做出决定。革兰氏染色（GS）是一种广泛使用的测试方法，但由于PJI诊断中结果相互矛盾，其价值仍然存在争议。因此，本研究的目的是评估GS在PJI诊断中的价值。使用MEDLINE，EMBASE和OVID数据库对1990年1月至2013年12月之间发布的数据进行了搜索。荟萃分析用于汇总灵敏度，特异性，诊断比值（DOR），接收者操作特征曲线（AUC）下的面积，正似然比（PLR），负似然比（NLR）和测试后概率。评估异质性和发表偏见，并进行亚组和亚回归分析。总共选择了18项研究，包括4,647例患者进行了分析。诊断PJI的合并敏感性和特异性值分别为0.19和1.00。 AUC，PLR和NLR分别为0.89、41.6和0.82。亚组分析表明，全髋关节置换的敏感性/特异性为0.14 / 0.99，而全膝关节置换的敏感性/特异性为0.14 / 1.00。滑液最能准确反映基于GS的诊断，DOR最高，为242，而组织的AUC最高，为0.96（95％CI，0.94-0.97）。 GS对检测PJI的临床诊断价值较差。这些数据不支持在没有其他感染证据的情况下常规使用GS诊断PJI。取而代之的是，GS可以用作辅助工具来支持其他调查的结果。

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