当前诊断技术在诊断骨折相关感染中的价值:血清标记物、组织学和培养。

IF 2.2 3区 医学 Q3 CRITICAL CARE MEDICINE Injury-International Journal of the Care of the Injured Pub Date : 2024-11-01 DOI:10.1016/j.injury.2024.111862
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引用次数: 0

摘要

虽然骨折相关感染(FRI)是骨折后的一种严重并发症,但全面的定义和诊断标准直到近几年才出现。根据这一共识定义,FRI 的诊断基于术前和术中的提示或确诊标准。血清标记物、组织学和微生物培养被认为在 FRI 诊断过程中起着至关重要的作用。然而,在 2018 年发布 FRI 共识定义并在 2020 年进行更新时,关于这些诊断方法准确性的数据还很有限。本综述旨在概述近期发表的文章,并讨论是否已获得有关这些现有诊断技术价值的新证据。同时,一些研究证实了 C 反应蛋白、红细胞沉降比值和白细胞计数的预后价值有限。用于 FRI 术前诊断的其他血清学标志物具有良好的诊断效果,如 d-二聚体、血浆纤维蛋白原、血小板计数与平均血小板体积比值,以及除血液标志物外还包括软组织损伤类型和骨折复杂性的风险预测模型。然而,这些指标在日常临床实践中的真正诊断价值还需要进一步研究。组织学在 FRI 诊断中的数据仍然有限,但其作为确诊标准的潜力似乎在于其高度特异性。最近的研究表明,组织培养具有中等的灵敏度和较高的特异性,通过对五个标本进行取样和长期培养可提高灵敏度。种植体超声似乎也能提高培养的灵敏度和多微生物感染的检出率。总之,诊断技术的真正价值很难评估,部分原因是它是根据金标准来衡量的,而金标准本身并不完善且仍在不断发展,另外还因为样本处理方法的差异或使用不同的阈值。尽管如此,本综述发现,当前诊断技术在联合使用时具有很高的价值。为了对血清标记物、组织学和培养(包括超声)的价值得出更准确的结论,未来的研究应该是前瞻性的,并在取样和方法规程上采用更高的标准化。
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The value of current diagnostic techniques in the diagnosis of fracture-related infections: Serum markers, histology, and cultures
Although fracture-related infection (FRI) is a serious complication following bone fractures, a comprehensive definition and diagnostic criteria have only emerged in recent years. According to this consensus definition, the diagnosis of FRI is based on preoperative and intraoperative suggestive or confirmatory criteria. Serum markers, histology, and microbiological cultures are considered to play a crucial role in the FRI diagnostic pathway. However, at the time of publication of the FRI consensus definition in 2018 and its update in 2020, limited data was available on the accuracy of these diagnostic methods. This review aims to provide an overview of recent publications and discuss whether new evidence has been obtained regarding the value of these current diagnostic techniques.
Meanwhile, several studies have confirmed the limited prognostic value of C-reactive protein, erythrocyte sedimentation ratio, and white blood cell count. Other serologic markers for preoperative diagnosis of FRI with promising diagnostic performance are d-dimer, plasma fibrinogen, platelet count to mean platelet volume ratio, and a risk prediction model that includes soft tissue injury type and fracture complexity in addition to blood markers. However, their true diagnostic value in daily clinical practice needs to be investigated in further studies. Data on histology in FRI diagnosis is still limited, but its potential as a confirmatory criterion seems to lie in its high specificity. Recent studies indicate that tissue culture exhibits moderate sensitivity and high specificity, with sensitivity improvements achieved by sampling of five specimens and long-term culture. Implant sonication also appears to enhance the sensitivity of culture and the detection rate of polymicrobial infections.
In conclusion, the true value of diagnostic techniques is difficult to assess, in part because it is measured against a gold standard that is itself imperfect and still evolving, but also because of methodological differences in sample processing or the use of different thresholds. Nevertheless, this review has identified that the value of current diagnostic techniques is high when used in combination. To draw more accurate conclusions about the value of serum markers, histology, and culture including sonication, future studies should be prospective and utilize a greater standardization in sampling and methodological protocols.
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来源期刊
CiteScore
4.00
自引率
8.00%
发文量
699
审稿时长
96 days
期刊介绍: Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.
期刊最新文献
Editorial Board Fracture-related infection blood-based biomarkers: Diagnostic strategies The value of current diagnostic techniques in the diagnosis of fracture-related infections: Serum markers, histology, and cultures Antimicrobial resistance: Biofilms, small colony variants, and intracellular bacteria In vivo models of infection: Large animals – Mini review on human-scale one-stage revision in a porcine osteomyelitis model
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