The role of alpha defensin in prosthetic joint infection (PJI) diagnosis: a literature review

Tommaso Bonanzinga, Matteo Carlo Ferrari, Giuseppe Tanzi, Filippo Vandenbulcke, Akos Zahar, Maurilio Marcacci, Tommaso Bonanzinga, Matteo Carlo Ferrari, Giuseppe Tanzi, Filippo Vandenbulcke, Akos Zahar, Maurilio Marcacci

Abstract

Prosthetic joint infection (PJI) management is not standardized worldwide and the outcome is frequently unsatisfactory.More and more arthroplasties are now being performed. An increasing number of highly virulent and antibiotic-resistant bacteria and an ageing population of patients presenting with many comorbidities make it necessary to focus on this important topic.Diagnosis of PJI remains challenging because the clinical signs and symptoms and elevation of systemic biomarkers (C-reactive protein, erythrocyte sedimentation rate) may be unclear.In the last few years, the clinical research has focused on synovial fluid biomarkers as a possible breakthrough in the complex scenario of PJI diagnosis.Synovial biomarkers have shown encouraging results and they should be used as diagnostic adjuncts to synovial white cell count and culture bacteriology. Synovial leukocyte esterase (LE) and synovial C-reactive protein (CRP) have been evaluated as good screening measures; however, the most promising synovial fluid biomarker in terms of sensitivity and specificity for PJI seems to be alpha defensin (AD).The laboratory-based alpha defensin enzyme-linked immunosorbent assay (ELISA) test demonstrated the highest ever reported accuracy for PJI diagnosis. However, an alpha defensin lateral flow test could have its place in ruling in a suspected PJI intraoperatively because of its high specificity and rapid results. Cite this article: EFORT Open Rev 2019;4:10-13. DOI: 10.1302/2058-5241.4.180029.

Keywords: PJI; alpha defensin; prosthetic joint infections; synovial biomarkers.

Conflict of interest statement

ICMJE Conflict of interest statement: A. Zahar declares provision of writing assistance, medicines, equipment, or administrative support, consultancy, and payment for lectures from Zimmer Biomet; payment for development of educational presentations from Waldemar Link & Co KG; travel/accommodation/meeting expenses from Bonesupport; payment for lectures from Heraeus Medical, activities outside the submitted work. M. C. Ferrari declares travel/accommodation/meeting expenses from ICM Philadelphia and EBJIS Helsinki, activities outside the submitted work.

References

    1. Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 2009;91:128–133.
    1. Bozic KJ, Kurtz SM, Lau E, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010;468:45–51.
    1. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004;351:1645–1654.
    1. Trampuz A, Widmer AF. Infections associated with orthopedic implants. Curr Opin Infect Dis 2006;19:349–356.
    1. Jafari SM, Coyle C, Mortazavi SM, et al. Revision hip arthroplasty: infection is the most common cause of failure. Clin Orthop Relat Res 2010;468:2046–2051.
    1. Austin MS, Ghanem E, Joshi A, et al. A simple, cost-effective screening protocol to rule out periprosthetic infection. J Arthroplasty 2008;23:65–68.
    1. Bedair H, Ting N, Jacovides C, et al. The Mark Coventry Award: diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Relat Res 2011;469:34–40.
    1. DellaValle CJ, Sporer SM, Jacobs JJ, et al. Preoperative testing for sepsis before revision total knee arthroplasty. J Arthroplasty 2007;22:90–93.
    1. Fehring TK, McAlister JA., Jr Frozen histologic section as a guide to sepsis in revision joint arthroplasty. Clin Orthop Relat Res 1994;304:229–237.
    1. Ghanem E, Antoci V, Jr, Pulido L, et al. The use of receiver operating characteristics analysis in determining ESR and CRP levels in diagnosing periprosthetic infection prior to revision total hip arthroplasty. Int J Infect Dis 2009;13:e444–449.
    1. Ghanem E, Parvizi J, Burnett RS, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am 2008;90:1637–1643.
    1. Tsaras G, Maduka-Ezeh A, Inwards CY, et al. Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systemic review and meta-analysis. J Bone Joint Surg Am 2012;94:1700–1711.
    1. Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 2011;469:2992–2994.
    1. International Consensus on Periprosthetic Joint Infection. (date late accessed 16 December 2013).
    1. Deirmengian C, Kardos K, Kilmartin P, et al. Diagnosing periprosthetic joint infection: has the era of the biomarker arrived? Clin Orthop Relat Res 2014;472:3254–3262.
    1. Deirmengian C, Kardos K, Kilmartin P, et al. Combined measurement of synovial fluid alpha-defensin and CRP levels: highly accurate for diagnosing periprosthetic joint infection. J Bone Joint Surg Am 2014;96:1439–1445.
    1. Bingham J, Clarke H, Spangehl M, et al. The alpha-defensin-1 biomarker assay can be used to evaluate the potentially infected total joint arthroplasty. Clin Orthop Relat Res 2014;472:4006–4009.
    1. Deirmengian C, Kardos K, Kilmartin P, et al. The alpha-defensin test for periprosthetic joint infection outperforms the leukocyte esterase test strip. Clin Orthop Relat Res 2015;473:2229–2235.
    1. Wyatt MC, Beswick AD, Kunutsor SK, et al. The alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of periprosthetic infection: a systematic review and meta-analysis. J Bone Joint Surg Am 2016;98:992–1000.
    1. Shahi A, Parvizi J, Kazarian GS, et al. The alpha-defensin test for periprosthetic joint infections is not affected by prior antibiotic administration. Clin Orthop Relat Res 2016;474:1610–1615.
    1. Li B, Chen F, Liu Y, et al. Synovial fluid alpha-defensin as a biomarker for peri-prosthetic joint infection: a systematic review and meta-analysis. Surg Infect (Larchmt) 2017;18:1–7.
    1. Bonanzinga T, Zahar A, Dütsch M, et al. How reliable is the alpha-defensin immunoassay test for diagnosing periprosthetic joint infection? A prospective study. Clin Orthop Relat Res 2017;475:408–415.
    1. Gehrke T, Lausmann C, Citak M, et al. The accuracy of the alpha defensin lateral flow device for diagnosis of periprosthetic joint infection: comparison with a gold standard. J Bone Joint Surg Am 2018;100:42–48.
    1. Ahmad SS, Hirschmann MT, Becker R, et al. A meta-analysis of synovial biomarkers in periprosthetic joint infection: Synovasure™ is less effective than the ELISA-based alphadefensin test. Knee Surg Sports Traumatol Arthrosc 2018;26:3039–3047.
    1. Suen K, Keeka M, Ailabouni R, et al. Synovasure ‘quick test’ is not as accurate as the laboratory-based α-defensin immunoassay. Bone Joint J 2018;100-B:66–72.
    1. Eriksson HK, Nordström J, Gabrysch K, et al. Does the alpha-defensin immunoassay or the lateral flow test have better diagnostic value for periprosthetic joint infection? A systematic review. Clin Orthop Relat Res 2018;476:1065–1072.
    1. Renz N, Yermak K, Perka C, et al. Alpha defensin lateral flow test for diagnosis of periprosthetic joint infection: not a screening but a confirmatory test. J Bone Joint Surg Am 2018;100:742–750.
    1. Parvizi J, Tan TL, Goswami K, et al. The 2018 definition of periprosthetic hip and knee infection: an evidenced-based and validated criteria. J Arthroplasty 2018;33:1309–1314e2.
    1. Patel R, Alijanipour P, Parvizi J. Advancements in diagnosing periprosthetic joint infections after total hip and knee arthroplasty. Open Orthop J 2016;10: 654–661.
    1. Lee YS, Koo K-H, Kim HJ, et al. Synovial fluid biomarkers for the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am 2017;99:2077–2084.
    1. Tischler EH, Cavanaugh PK, Parvizi J. Leukocyte esterase strip test: matched for musculoskeletal infection society criteria. J Bone Joint Surg Am 2014;96: 1917–1920.
    1. Parvizi J, Jacovides C, Antoci V, et al. Diagnosis of periprosthetic joint infection: the utility of a simple yet unappreciated enzyme. J Bone Joint Surg Am 2011;93:2242–2248.
    1. Sigmund IK, Holinka J, Gamper J, et al. Qualitative a-defensin test (Synovasure) for the diagnosis of periprosthetic infection in revision total joint arthroplasty. Bone Joint J 2017;99-B:66–72.
    1. Tetreault MW, Wetters NG, Moric M, et al. Is synovial Creactive protein a useful marker for periprosthetic joint infection? Clin Orthop Relat Res 2014;472:3997–4003.
    1. Omar M, Ettinger M, Reichling M, et al. Synovial C-reactive protein as a marker for chronic periprosthetic infection in total hip arthroplasty. Bone Joint J 2015;97-B:173–176.
    1. Ganz T, Selsted ME, Szklarek D, et al. Defensins: natural peptide antibiotics of human neutrophils. J Clin Invest 1985;76:1427–1435.
    1. Lehrer RI, Ganz T. Defensins: endogenous antibiotic peptides from human leukocytes. Ciba Found Symp 1992;171:276–290.

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