Ultrasonography performed by an infectiologist in hip and knee prosthetic joint and native joint infections - 27/07/23
, Julie Leitao a, Maëlig Lescure a, Emilie Shipley b, Jean Mazé c, Arnaud Desclaux a, Hervé Dutronc a, Didier Neau a, Frédéric-Antoine Dauchy aHighlights |
• | Clinical ultrasonography by infectiologists has only recently been developing and the data in the literature are limited. |
• | Ultrasonography can be performed and interpreted by a clinician at the patient’s bedside (Point-Of-Care Ultrasound [POCUS]), and provides immediate results. |
• | While the sensitivity of ultrasonography in detection of joint effusion and periprosthetic collectionsis high, when used alone its specificity is low. |
• | Ultrasonography combined with fluid aspiration analysis improves specificity and PPV. |
Abstract |
Introduction |
Clinical ultrasonography (US) by infectiologists has only recently been developing, and as now there is little literature on the subject. Our study focuses on the conditions and diagnostic performance of clinical ultrasound imaging by infectiologists in cases of hip and knee prosthetic and native joint infection.
Methods |
A retrospective study carried out between June 1st 2019 and March 31st 2021 in the University Hospital of Bordeaux, South-Western France. We measured US sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV), combined or not with the analysis of articular fluid, compared to the MusculoSketetal Infection Society (MSIS) score in prosthetic joints, or to expert diagnosis in native joints.
Results |
Fifty-four patients underwent US by an infectiologist in an infectious disease ward, including 11 (20.4%) for native joint and 43 (79.6%) for prosthetic joint. Joint effusion and/or periarticular collection were highlighted in 47 (87%) patients, and US led to 44 punctures. In all patients (n = 54), Se, Sp, PPV and NPV of US alone were 91%, 19%, 64% and 57%, respectively. When US was combined with fluid analysis, Se, Sp, PPV, NPV were 68%, 100%, 100%, 64% in all patients (n = 54), 86%, 100%, 100%, 60% in acute arthritis (n = 17) and 50%, 100%, 100% and 65% respectively in non-acute arthritis (n = 37).
Conclusion |
These results suggest that US by infectiologists effectively diagnoses osteoarticular infections (OAIs). This approach has many applications in infectiology routines. Consequently, it would be interesting to define the contents of a first level of infectiologist competence in US clinical practice.
Le texte complet de cet article est disponible en PDF.Keywords : Ultrasonography, Infectiologist, Hip and knee infections, Diagnosis, Performance
Plan
Vol 53 - N° 5
Article 104689- août 2023 Retour au numéro
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