Prosthetic joint infection development of an evidence-based diagnostic algorithm
Identifieur interne : 000261 ( Main/Exploration ); précédent : 000260; suivant : 000262Prosthetic joint infection development of an evidence-based diagnostic algorithm
Auteurs : Heinrich M. L. Mühlhofer [Allemagne] ; Florian Pohlig [Allemagne] ; Karl-Georg Kanz [Allemagne] ; Ulrich Lenze [Allemagne] ; Florian Lenze [Allemagne] ; Andreas Toepfer [Allemagne] ; Sarah Kelch [Allemagne] ; Norbert Harrasser [Allemagne] ; Rüdiger Von Eisenhart-Rothe [Allemagne] ; Johannes Schauwecker [Allemagne]Source :
- European Journal of Medical Research [ 0949-2321 ] ; 2017.
Abstract
Increasing rates of prosthetic joint infection (PJI) have presented challenges for general practitioners, orthopedic surgeons and the health care system in the recent years. The diagnosis of PJI is complex; multiple diagnostic tools are used in the attempt to correctly diagnose PJI. Evidence-based algorithms can help to identify PJI using standardized diagnostic steps.
We reviewed relevant publications between 1990 and 2015 using a systematic literature search in MEDLINE and PUBMED. The selected search results were then classified into levels of evidence. The keywords were prosthetic joint infection, biofilm, diagnosis, sonication, antibiotic treatment, implant-associated infection,
From an initial 768 publications, 156 publications were stringently reviewed. Publications with class I–III recommendations (EAST) were considered. We developed an algorithm for the diagnostic approach to display the complex diagnosis of PJI in a clear and logically structured process according to ISO 5807.
The evidence-based standardized algorithm combines modern clinical requirements and evidence-based treatment principles. The algorithm provides a detailed transparent standard operating procedure (SOP) for diagnosing PJI. Thus, consistently high, examiner-independent process quality is assured to meet the demands of modern quality management in PJI diagnosis.
Url:
DOI: 10.1186/s40001-017-0245-1
PubMed: 28274250
PubMed Central: 5343418
Affiliations:
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Mühlhofer</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Pohlig, Florian" sort="Pohlig, Florian" uniqKey="Pohlig F" first="Florian" last="Pohlig">Florian Pohlig</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, 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type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Toepfer, Andreas" sort="Toepfer, Andreas" uniqKey="Toepfer A" first="Andreas" last="Toepfer">Andreas Toepfer</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Kelch, Sarah" sort="Kelch, Sarah" uniqKey="Kelch S" first="Sarah" last="Kelch">Sarah Kelch</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Harrasser, Norbert" sort="Harrasser, Norbert" uniqKey="Harrasser N" first="Norbert" last="Harrasser">Norbert Harrasser</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Von Eisenhart Rothe, Rudiger" sort="Von Eisenhart Rothe, Rudiger" uniqKey="Von Eisenhart Rothe R" first="Rüdiger" last="Von Eisenhart-Rothe">Rüdiger Von Eisenhart-Rothe</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Schauwecker, Johannes" sort="Schauwecker, Johannes" uniqKey="Schauwecker J" first="Johannes" last="Schauwecker">Johannes Schauwecker</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der 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L." last="Mühlhofer">Heinrich M. L. Mühlhofer</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Pohlig, Florian" sort="Pohlig, Florian" uniqKey="Pohlig F" first="Florian" last="Pohlig">Florian Pohlig</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Kanz, Karl Georg" sort="Kanz, Karl Georg" uniqKey="Kanz K" first="Karl-Georg" last="Kanz">Karl-Georg Kanz</name><affiliation wicri:level="4"><nlm:aff id="Aff2">Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Lenze, Ulrich" sort="Lenze, Ulrich" uniqKey="Lenze U" first="Ulrich" last="Lenze">Ulrich Lenze</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Lenze, Florian" sort="Lenze, Florian" uniqKey="Lenze F" first="Florian" last="Lenze">Florian Lenze</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Toepfer, Andreas" sort="Toepfer, Andreas" uniqKey="Toepfer A" first="Andreas" last="Toepfer">Andreas Toepfer</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Kelch, Sarah" sort="Kelch, Sarah" uniqKey="Kelch S" first="Sarah" last="Kelch">Sarah Kelch</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Harrasser, Norbert" sort="Harrasser, Norbert" uniqKey="Harrasser N" first="Norbert" last="Harrasser">Norbert Harrasser</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Von Eisenhart Rothe, Rudiger" sort="Von Eisenhart Rothe, Rudiger" uniqKey="Von Eisenhart Rothe R" first="Rüdiger" last="Von Eisenhart-Rothe">Rüdiger Von Eisenhart-Rothe</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author><author><name sortKey="Schauwecker, Johannes" sort="Schauwecker, Johannes" uniqKey="Schauwecker J" first="Johannes" last="Schauwecker">Johannes Schauwecker</name><affiliation wicri:level="4"><nlm:aff id="Aff1">Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université technique de Munich</orgName></affiliation></author></analytic><series><title level="j">European Journal of Medical Research</title><idno type="ISSN">0949-2321</idno><idno type="eISSN">2047-783X</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Increasing rates of prosthetic joint infection (PJI) have presented challenges for general practitioners, orthopedic surgeons and the health care system in the recent years. The diagnosis of PJI is complex; multiple diagnostic tools are used in the attempt to correctly diagnose PJI. Evidence-based algorithms can help to identify PJI using standardized diagnostic steps.</p></sec><sec><title>Methods</title><p>We reviewed relevant publications between 1990 and 2015 using a systematic literature search in MEDLINE and PUBMED. The selected search results were then classified into levels of evidence. The keywords were prosthetic joint infection, biofilm, diagnosis, sonication, antibiotic treatment, implant-associated infection, <italic>Staph. aureus</italic>, rifampicin, implant retention, pcr, maldi-tof, serology, synovial fluid, c-reactive protein level, total hip arthroplasty (THA), total knee arthroplasty (TKA) and combinations of these terms.</p></sec><sec><title>Results</title><p>From an initial 768 publications, 156 publications were stringently reviewed. Publications with class I–III recommendations (EAST) were considered. We developed an algorithm for the diagnostic approach to display the complex diagnosis of PJI in a clear and logically structured process according to ISO 5807.</p></sec><sec><title>Conclusions</title><p>The evidence-based standardized algorithm combines modern clinical requirements and evidence-based treatment principles. The algorithm provides a detailed transparent standard operating procedure (SOP) for diagnosing PJI. Thus, consistently high, examiner-independent process quality is assured to meet the demands of modern quality management in PJI diagnosis.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Kurtz, S" uniqKey="Kurtz S">S Kurtz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Urquhart, Dm" uniqKey="Urquhart D">DM Urquhart</name></author><author><name sortKey="Hanna, Fs" uniqKey="Hanna F">FS Hanna</name></author><author><name sortKey="Brennan, Sl" uniqKey="Brennan S">SL Brennan</name></author><author><name sortKey="Wluka, Ae" uniqKey="Wluka A">AE Wluka</name></author><author><name sortKey="Leder, K" uniqKey="Leder K">K Leder</name></author><author><name sortKey="Cameron, Pa" uniqKey="Cameron P">PA Cameron</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zimmerli, W" uniqKey="Zimmerli W">W Zimmerli</name></author><author><name sortKey="Trampuz, A" 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sortKey="Berger, I" uniqKey="Berger I">I Berger</name></author><author><name sortKey="Frommelt, L" uniqKey="Frommelt L">L Frommelt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Saleh, Kj" uniqKey="Saleh K">KJ Saleh</name></author><author><name sortKey="Clark, Cr" uniqKey="Clark C">CR Clark</name></author><author><name sortKey="Sharkey, Pf" uniqKey="Sharkey P">PF Sharkey</name></author><author><name sortKey="Goldberg, Vm" uniqKey="Goldberg V">VM Goldberg</name></author><author><name sortKey="Rand, Ja" uniqKey="Rand J">JA Rand</name></author><author><name sortKey="Brown, Ga" uniqKey="Brown G">GA Brown</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Clarke, Mt" uniqKey="Clarke M">MT Clarke</name></author><author><name sortKey="Arora, A" uniqKey="Arora A">A Arora</name></author><author><name sortKey="Villar, Rn" uniqKey="Villar R">RN Villar</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Allemagne</li></country><region><li>Bavière</li><li>District de Haute-Bavière</li></region><settlement><li>Munich</li></settlement><orgName><li>Université technique de Munich</li></orgName></list><tree><country name="Allemagne"><region name="Bavière"><name sortKey="Muhlhofer, Heinrich M L" sort="Muhlhofer, Heinrich M L" uniqKey="Muhlhofer H" first="Heinrich M. L." last="Mühlhofer">Heinrich M. L. Mühlhofer</name></region><name sortKey="Harrasser, Norbert" sort="Harrasser, Norbert" uniqKey="Harrasser N" first="Norbert" last="Harrasser">Norbert Harrasser</name><name sortKey="Kanz, Karl Georg" sort="Kanz, Karl Georg" uniqKey="Kanz K" first="Karl-Georg" last="Kanz">Karl-Georg Kanz</name><name sortKey="Kelch, Sarah" sort="Kelch, Sarah" uniqKey="Kelch S" first="Sarah" last="Kelch">Sarah Kelch</name><name sortKey="Lenze, Florian" sort="Lenze, Florian" uniqKey="Lenze F" first="Florian" last="Lenze">Florian Lenze</name><name sortKey="Lenze, Ulrich" sort="Lenze, Ulrich" uniqKey="Lenze U" first="Ulrich" last="Lenze">Ulrich Lenze</name><name sortKey="Pohlig, Florian" sort="Pohlig, Florian" uniqKey="Pohlig F" first="Florian" last="Pohlig">Florian Pohlig</name><name sortKey="Schauwecker, Johannes" sort="Schauwecker, Johannes" uniqKey="Schauwecker J" first="Johannes" last="Schauwecker">Johannes Schauwecker</name><name sortKey="Toepfer, Andreas" sort="Toepfer, Andreas" uniqKey="Toepfer A" first="Andreas" last="Toepfer">Andreas Toepfer</name><name sortKey="Von Eisenhart Rothe, Rudiger" sort="Von Eisenhart Rothe, Rudiger" uniqKey="Von Eisenhart Rothe R" first="Rüdiger" last="Von Eisenhart-Rothe">Rüdiger Von Eisenhart-Rothe</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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