Post operative prosthetic joint infection (PJI) is the most common cause of failure of total joint arthroplasty, requiring revision surgery, but a gold standard for the diagnosis and the treatment of PIJ is still lacking [1]. SuPAR, the soluble urokinase plasminogen activation receptor, has been recently described as a powerful diagnostic and prognostic tool, able not only to detect sepsis but also to discriminate different grade of sepsis severity [2,3] This study aimed to examine the diagnostic value of SuPAR in post operative PJI, in order to explore the possible application of this new biomarker in the early diagnosis of PJI. The level of SuPAR have been measured in PJI patients and controls (patients undergoing prosthesis revision without infection), and correlated with pro and anti inflammatory markers (CRP C-reactive protein, IL-6, IL-1 TNFα, IL-10, IL-12, IL-8, IL1ra and the chemokine CCL2). Statistical analysis of Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC) was performed As described in Figure 1, serum SuPAR displayed a strongly significative increase in PJI patients compared to not infected controls, and a significative positive correlation with C-reactive protein, IL-6, IL-1 and TNFα and the chemokine CCL2. SuPAR displayed a very good AUC, significantly higher than CRP and IL-6 AUC This study clearly show that the measure of Serum level of SuPAR provide a extremely important benefit because it is a precise indicator of bacterial infection, and the addition of SuPAR serum level measurement to classical inflammatory markers can strongly improve the diagnosis of prosthesis joint infection The authors acknowledge ViroGates, Denmark for providing suPARNOSTIC Standard Kit. The authors would also acknowledge the Italian Ministero dell’ Istruzione, Università e Ricerca (MIUR) and Italian Ministero della Salute for providing funds for this research project.
The treatment of chronic osteomyelitis often
includes surgical debridement and filling the resultant void with antibiotic-loaded
polymethylmethacrylate cement, bone grafts or bone substitutes.
Recently, the use of bioactive glass to treat bone defects in infections
has been reported in a limited series of patients. However, no direct comparison
between this biomaterial and antibiotic-loaded bone substitute has
been performed. In this retrospective study, we compared the safety and efficacy
of surgical debridement and local application of the bioactive glass
S53P4 in a series of 27 patients affected by chronic osteomyelitis
of the long bones (Group A) with two other series, treated respectively
with an antibiotic-loaded hydroxyapatite and calcium sulphate compound
(Group B; n = 27) or a mixture of tricalcium phosphate and an antibiotic-loaded
demineralised bone matrix (Group C; n = 22). Systemic antibiotics
were also used in all groups. After comparable periods of follow-up, the control of infection
was similar in the three groups. In particular, 25 out of 27 (92.6%)
patients of Group A, 24 out of 27 (88.9%) in Group B and 19 out
of 22 (86.3%) in Group C showed no infection recurrence at means
of 21.8 (12 to 36), 22.1 (12 to 36) and 21.5 (12 to 36) months follow-up,
respectively, while Group A showed a reduced wound complication
rate. Our results show that patients treated with a bioactive glass
without local antibiotics achieved similar eradication of infection
and less drainage than those treated with two different antibiotic-loaded
calcium-based bone substitutes. Cite this article:
