Background
Methods
LoE | |
I | Prospective randomized controlled trials (ORCTs) |
II | Clinical studies in which the data was collected prospectively, and retrospective analyses which were based on clearly reliable data Types of studies so classified: observational studies, cohort studies, prevalence studies and case control studies |
III | Studies based on retrospectively collected data. Evidence used in this class indicate clinical series, database or registry review, large series of case reviews and expert opinion |
CoR | |
I | The recommendation is convincingly justifiable based on the available scientific information alone. This recommendation is usually based on Class I data; however, strong Class II evidence may form the basis for a level I recommendation, especially if the issue does not lead itself to testing in a randomized trial. |
II | The recommendation is reasonably justifiable by available scientific evidence and strongly supported by expert opinion This recommendation is usually supported by Class II data or a preponderance of Class II evidence |
III | The recommendation is supported by available data but adequate scientific evidence is lacking This recommendation is generally supported by Class III data. This type of recommendation is useful for educational purposes and in guiding future clinical research |
MSIS | IDSA | International consensus | ||||
---|---|---|---|---|---|---|
Main criteria | Supportive criteria | Main criteria | Supportive criteria | Main criteria | Supportive criteria | |
Sinus tract | o | o | o | |||
Identical microorganisms isolated form 2 or more cultures | o | o | o | |||
Purulence surrounding the prosthesis | o | o | ||||
Inflammation in histological examination of prosthetic tissue | o | o | o | |||
Single positive culture | o | o | ||||
Single positive culture with virulent microorganism | o | |||||
Elevated synovial fluid leukocyte count | o | o | ||||
Elevated synovial fluid neutrophil percentage | o | o | ||||
Elevated serum ESR and CRP values | o | o |
Results
Risk factors checklist
Author | Year | LoE | (n = x) | Risk factor | CoR |
---|---|---|---|---|---|
Huotari et al. | 2007 | LoE II |
n = 8201 | ||
Smarbrekke et al. | 2004 | LoE II |
n = 31,750 | ||
Kurtz et al. | 2010 | LoE II |
n = 69,663 | Extended time | CoR I |
Uckay et al. | 2009 | LoE I |
n = 6001 | ||
Berbari et al. | 1998 | LoE II |
n = 26,505 | ||
Dowsey et al. | 2009 | LoE III |
n = 1214 | ||
Peersman et al. | 2001 | LoE III |
n = 6120 | ||
Lübbeke et al. | 2007 | LoE II |
n = 2495 | ||
Dowsey et al. | 2008 | LoE III |
n = 1207 | ||
Pulido et al. | 2008 | LoE III |
n = 9245 | Obesity | CoR I |
Namba et al. | 2012 | LoE II |
n = 30,491 | ||
Namba et al. | 2013 | LoE II |
n = 56,216 | ||
Malinzak et al. | 2009 | LoE III |
n = 8494 | ||
Peel et al. | 2011 | LoE III |
n = 1200 | ||
Berbari et al. | 2012 | LoE III |
n = 678 | Malnutrition | CoR III |
Namba et al. | 2013 | LoE II |
n = 56,216 | ||
Malinzak et al. | 2009 | LoE III |
n = 8494 | Diabetes | CoR I |
Peersman et al. | 2001 | LoE III |
n = 6120 | ||
Mraovic et al. | 2011 | LoE III |
n = 1948 | ||
Dowsey et al. | 2008 | LoE III |
n = 1207 | ||
Peersman et al. | 2001 | LoE III |
n = 6120 | ||
Jämsen et al. | 2009 | LoE II |
n = 43,149 | Immunsuppression | CoR I |
Pulido et al. | 2008 | LoE II |
n = 9245 | ||
Peel et al. | 2011 | LoE III |
n = 63 | ||
Berbari et al. | 1998 | LoE II |
n = 26,505 | ||
Bongratz et al. | 2008 | LoE III |
n = 462 | ||
Jämsen et al. | 2009 | LoE II |
n = 43,149 | Prior infection | CoR II |
Aslam et al. | 2010 | LoE III |
n = 126 | ||
Coelho-Prabhu et al. | 2013 | LoE III |
n = 678 | Bacteremia | CoR III |
Murdoch et al. | 2001 | LoE III |
n = 80 | ||
Murray et al. | 1991 | Level III |
n = 159 | Metachronous infections | CoR III |
Luessenhop et al. | 1996 | Level III |
n = 145 | ||
Portillo et al. | 2013 | LoE I |
n = 116 | Implant loosening | CoR I |
Sousa et al. | 2013 | LoE III |
n = 2497 | Bacteriuria | CoR III |
Berbari et al. | 2010 | Level III |
n = 678 | Dental | CoR III |
Sepsis checklist
Physical exam
Author | Year | LoE | CoR | (n = x) | Sensitivity | Specificity | Positive predictive value | Negative predictive value | LR for a positive result | LR for a negative result |
---|---|---|---|---|---|---|---|---|---|---|
Teller et al. | 2000 | III | III | 166 | ||||||
Local signs | 0.18 (0.02–0.34) | 1 | 1 | 0.5 (0.34–0.66) | n.p. | 0.82 (0.66–0.98) | ||||
Fever | 0.9 (0.03–0.21) | 0.99 (0.98–1.00) | 0.67 (0.13–1.2) | 0.88 (0.83–0.93) | 13.09 (1.42–31.88) | 0.92 (0.78–1.05) |
Inflammatory markers
Author | Year | LoE | CoR | (n = x) | Sensitivity | Specificity | Positive predictive value | Negative predictive value | LR for a positive result | LR for a negative result |
---|---|---|---|---|---|---|---|---|---|---|
Bottner et al. | 2007 | I | I | 78 | ||||||
CRP (1.5 mg/dl) | 0.95 (0.86–1.0) | 0.91 (0.94–0.99) | 0.8 (0.64–0.96) | 0.98 (0.94–1.0) | 10.86 (5.3–73.07) | 0.05 (0.0–0.17) | ||||
ESR (32 mm/h) | 0.81 (0.64–0.98) | 0.89 (0.82–0.97) | 0.74 (0.56–0.92) | 0.93 (0.8–1.0) | 7.69 (3.47–38.2) | 0.21 (0.02–0.44) | ||||
Savarino et al. | 2004 | I | I | 26 | ||||||
ESR (50 mm/h) | 0.6 (0.3–0.9) | 0.94 (0.82–1.0) | 0.86 (0.71–1.0) | 0.79 (0.61–0.97) | 9.6 (1.64–16.1) | 0.43 (0.09–0.86) | ||||
CRP (2 mg/dl) | 0.38 (0.14–0.61) | 0.7 (0.42–0.98) | 0.67 (0.36–0.97) | 0.42 (0.18–0.65) | 1.25 (0.24–38.34) | 0.89 (0.39–2.07) | ||||
Kamme et al. | 1980 | I | I | 63 | ||||||
ESR(30 mm/h) | 0.89 (0.8–0.99) | 0.72 (0.54–0.9) | 0.83 (0.71–0.94) | 0.82 (0.66–0.98) | 3.2 (1.75–9.54) | 0.15 (0.01–0.37) | ||||
Greidanus et al. | 2007 | I | I | 151 | ||||||
ESR (30 mm/h) | 0.82 (0.71–0.93) | 0.88 (0.81–0.94) | 0.74 (0.62–0.86) | 0.92 (0.87–0.97) | 6.7 (3.84–15.52) | 0.2 (0.07–0.36) | ||||
CRP (1.0 mg/dl) | 0.93 (0.86–1.0) | 0.83 (0.76–0.9) | 0.7 (0.58–0.82) | 0.97 (0.93–1.0) | 5.5 (3.57–10.23 | 0.08 (0.01–0.18) | ||||
Della Valle et al. | 2007 | I | I | 94 | ||||||
ESR (30 mm/h) | 0.9 (0.81–0.99) | 0.66 (0.53–0.79) | 0.67 (0.55–0.8) | 0.9 (0.8–0.99) | 2.66 (1.74–4.68) | 0.15 (0.01–0.35) | ||||
CRP (1 mg/dl) | 0.95 (0.89–1.00) | 0.75 (0.64–0.87) | 0.75 (0.63–0.87) | 0.95 (0.89–1.0) | 3.88 (2.45–7.86) | 0.06 (0.02–0.18) | ||||
Schinsky et al. | 2008 | I | I | 201 | ||||||
ESR (30 mm/h) | 0.96 (0.91–1.0) | 0.39 (0.31–0.47) | 0.37 (0.29–0.45) | 0.97 (0.92–1.0) | 1.58 (1.33–1.91) | 0.09 (0.0–0.28) | ||||
CRP (1 mg/dl) | 0.95 (0.89–1.0) | 0.71 (0.94–1.0) | 0.55 (0.45–0.65) | 0.97 (0.94–1.0) | 3.29 (2.45–4.69) | 0.08 (0.0–0.18) | ||||
Fink et al. | 2007 | I | I | 145 | ||||||
CRP (1.35 mg/dl) | 0.73 (0.59–0.86) | 0.81 (0.73–0.88) | 0.59 (0.45–0.73) | 0.89 (0.82–0.95) | 3.81 (2.21–7.48) | 0.34 (0.15–0.56) | ||||
Bottner et al. | 2007 | I | I | 78 | 0.95 | 0.87 | 0.74 | 0.98 | n.p. | n.p. |
IL-6 (>12 pg/ml) | 0.43 | 0.94 | 0.75 | 0.85 | n.p. | n.p. | ||||
TNF-a (>40 nl/ml) | 0.33 | 0.98 | 0.87 | 0.8 | n.p. | n.p. | ||||
PCT (>0.3 ng/ml) | ||||||||||
Di Cesare et al. | 2005 | III | III | 58 | ||||||
Il-6 (>10 pg/ml) | 1 | 0.95 (0.89–1.0) | 0.88 (0.73–1.0) | 1 | 21.5 (9.14–60.85) | 0 |
Sinus tract
Joint aspiration (knee)
Author | Year | LoE | CoR | (n = x) | Sensitivity | Specificity | Positive predictive value | Negative predictive value | LR for a positive result | LR for a negative result |
---|---|---|---|---|---|---|---|---|---|---|
Della Valle et al. | 2007 | I | I | 94 | ||||||
Aspiration culture | 0.8 | 0.93 | 0.94 | 0.84 | n.p. | n.p. | ||||
WBC (3.0 × 103) | 0.98 (0.93–1.9) | 1 | 1 | 0.98 (0.94–1.0) | X | 0.02 | ||||
Neutrophile-% | 0.98 (0.93–1.0) | 0.85 (0.75–0.95) | 0.83 (0.73–0.94) | 0.98 (0.94–1.0) | 6.46 (3.75–18.75) | 0.03 (0–0.1) | ||||
Fink et al. | 2007 | I | I | 145 | ||||||
Aspiration culture | 0.73 (0.59–0.86) | 0.95 (0.91–0.99) | 0.85 (0.73–0.97) | 0.9 (0.85–0.96) | 15.23 (6.64–125.4) | 0.29 (0.14–0.45) | ||||
Ghanem et al. | 2008 | I | I | 429 | ||||||
WBC (3.0 × 103) | 0.91 (0.86–0.95) | 0.88 (0.84–0.92) | 0.82 (0.76–0.88) | 0.94 (0.91–0.97) | 7.59 (5.45–11.81) | 0.11 (0.05–0.16) | ||||
Neutorphile (64%) | 0.95 (0.92–0.98) | 0.95 (0.92–0.97) | 0.92 (0.87–0.96) | 0.97 (0.95–0.99) | 18.19 (11.62–38.43) | 0.05 (0.02–0.09) | ||||
Trampuz et al. | 2007 | I | I | |||||||
WBC (1.7 × 103) | 0.94 (0.86–1.0) | 0.88 (0.81–0.94) | 0.73 (0.60–0.86) | 0.98 (0.95–1.0) | 7.76 (4.65–17.92) | 0.07 (0.0–0.17) | ||||
Neutrophi (65%) | 0.97 (0.91–1.0) | 0.98 (0.95–1.0) | 0.94 (0.87–1.0) | 0.99 (0.97–1.0) | 48.04 (19.07–136.76) | 0.03 (0.0–0.09) | ||||
Zmistowski et al. | 2012 | I | I | 150 | ||||||
WBC (3.0 × 103) | 0.93 (0.87–0.99) | 0.94 (0.88–0.99) | 0.93 (0.87–0.99 | 0.94(0.88–0.99) | 14.35 (7.28–99) | 0.07 (0.01–0.14) | ||||
Neutrophile (75%) | 0.93 (0.87–0.99) | 0.83 (0.75–0.91) | 0.84 (0.76–0.92) | 0.93 (0.87–0.99) | 5.52(3.46–11.62) | 0.08 (0.01–0.17) |
Joint aspiration (hip)
Author | Year | LoE | CoR | (n = x) | Sensitivity | Specificity | Positive predictive value | Negative predictive value | LR for a positive result | LR for a negative result |
---|---|---|---|---|---|---|---|---|---|---|
Barrack et al. | 1993 | I | I | 291 | ||||||
Aspiration culture | 0.6 (0.3–0.9) | 0.88 (0.84–0.92) | 0.15 (0.04–0.27) | 0.98 (0.97–1.0) | 5.11 (1.91–11.32) | 0.45 (0.1–0.83) | ||||
Mulcahy et al. | 1996 | I | I | 71 | ||||||
Aspiration culture | 0.69 (0.46–0.91) | 0.91 (0.83–0.99) | 0.69 (0.46–0.91) | 0.91 (0.83–0.99) | 7.56 (2.76–61.25) | 0.34 (0.09–0.65) | ||||
Williams et al. | 2004 | I | I | 273 | ||||||
Aspiration culture | 0.8 (0.71–0.9) | 0.94 (0.9–0.97) | 0.81 (0.72–0.91) | 0.93 (0.90–0.97) | 12.47 (7.23–29.34) | 0.21 (0.11–0.32) | ||||
Malhotra et al. | 2004 | I | I | 41 | ||||||
Aspiration culture | 0.44 (0.12–0.77) | 0.91 (0.81–1.0) | 0.57 (0.2–0.94) | 0.85 (0.73–0.97) | 4.74 (0.62–106.19) | 0.61 (0.23–1.09) | ||||
Schinsky et al. | 2008 | I | I | 201 | ||||||
Wbc (4.2 × 103) | 0.84 (0.74–0.93) | 0.93 (0.89–0.97) | 0.82 (0.72–0.92) | 0.94 (0.90–0.98) | 12.21 (6.75–33.94) | 0.18 (0.07–0.29) | ||||
Neutrophile (80%) | 0.82 (0.72–0.92) | 0.83 (0.77–0.89) | 0.64 (0.53–0.76) | 0.92 (0.88–0.97) | 4.78 (3.08–8.36) | 0.22 (0.09–0.37) | ||||
Spanghel et al. | 1999 | I | I | 183 | ||||||
WBC (5.0 × 103) | 0.36 (0.18–0.53) | 0.99 (0.98–1.0) | 0.91 (0.74–1.0) | 0.9 (0.85–0.94) | 55.36 (9.43–86.89) | 0.65 (0.46–0.84) | ||||
Neutrophile (80%) | 0.89 (0.78–1.0) | 0.85 (079–0.91) | 0.52 (0.38–0.66) | 0.98 (0.95–1.0) | 5.94 (3.76–10.75) | 0.13 (0.0–0.28) | ||||
Dinneen et al. | 2013 | I | I | 75 | ||||||
WBC (1.58 × 103) | 0.895 (0.783–0.997) | 0.913 (0.827–0.999) | n.p. | n.p. | n.p. | n.p. | ||||
Neutrophile (65%) | 0.897 (0.795–0.999) | 0.866 (0.761–0.971) | n.p. | n.p. | n.p. | n.p. |
Synovial biopsy histological workup
Author | Year | LoE | CoR | (n = x) | Sensitivity | Specifity | Positive predictive value | Negative predictive value | LR for a positive result | LR for a negative result |
---|---|---|---|---|---|---|---|---|---|---|
Banit et al. | 2002 | I | I | |||||||
Frozen section (Hip) | 63 | 0.45 (0.16–0.75) | 0.92 (0.85–1.0) | 0.56 (0.23–0.88) | 0.89 (0.81–0.97) | 5.91 (1.07–166.5) | 0.59 (0.25–0.99) | |||
Frozen section (knee) | 55 | 1 | 0.96 (0.9–1.0) | 0.82 (0.59–1.0) | 1 | 23.00 (9.76–64.7) | 0 | |||
(Knee + hip.shoulder) | 121 | 0.67 (0.48–0.86) | 0.95 (0.91–1.0) | 0.8 (0.62–0.98) | 0.91 (0.86–0.97) | 14.67 (5.37–442) | 0.35 (0.15–0.57) | |||
Borrego et al. | 2007 | I | I | |||||||
Frozen sectio (Hip) | 83 | 0.5 (0.15–0.85) | 1 | 1 | 0.95 (0.9–1.0) | X | 0.5 (0.15–0.85) | |||
Frozen section (knee) | 63 | 0.67 (0.48–0.86) | 0.9 (0.8–0.99) | 0.8 (0.62–0.98) | 0.81 (0.7–0.93) | 6.5 (2.42–116.4) | 0.37 (0.15–0.65) | |||
Schinsky et al. | 2008 | I | I | 201 | ||||||
Frozen section | 0.73 (0.61–0.84) | 0.94 (0.9–0.98) | 0.82 (0.71–0.92) | 0.9 (0.85–0.95) | 11.8 (6.06–37.34) | 0.29 (0.16–0.43) | ||||
Fink et al. | 2008 | I | I | 145 | ||||||
Fixed section (knee) | 1 | 0.98 (0.95–1.0) | 0.95 (0.89–1.0) | 1 | 52.5 (22.13–140.88) | X | ||||
Tissue culture (knee) | 0.78 (0.65–0.9) | 0.98 (0.95–1.0) | 0.94 (0.86–1.0) | 0.92 (0.87–0.97) | 40.69 (14.28–127.41) | 0.23 (0.09–0.37) | ||||
Both | 0.78 (0.65–0.9) | 0.98 (0.95–1.0) | 0.94 (0.86–1.0) | 0.92 (0.87–0.97) | 40.69 (14.28–127.41) | 0.23 (0.09–0.37) | ||||
Della Valle et al. | 2007 | I | I | 94 | ||||||
Forzen section | 0.88 (0.78–0.98) | 0.96 (0.91–1.0) | 0.95 (0.88–1.0) | 0.91 (0.84–0.99) | 23.27 (8.74–72.1) | 0.13 (0.02–0.24) | ||||
Fink et al. | 2013 | I | I | 100 | ||||||
Fixed section (hip) | 0.62 (0.48–0.76) | 1 | 1 | 0.76 (0.67–0.86) | X | 0.38 (0.24–0.52) | ||||
Tissue culture (hip) | 0.73 (0.6–0.86) | 0.98 (0.95–1.0) | 0.97 (0.91–1.0) | 0.82 (0.73–0.91) | 40.33 (11.29–50.36) | 0.27 (0.14–0.42) | ||||
Both | 0.82 (0.71–0.93) | 0.98 (0.95–1.0) | 0.97 (0.92–1.0) | 0.87 (0.06–0.31) | 45.22 (13.28–54.52) | 0.18 (0.06–0.31) |