Abstract
Objectives
The objective was to identify the best performance among the criteria most currently used for the diagnosis of PPI using the database of patients undergoing revision TKA surgery in a SUS hospital specializing in highly complex orthopedic surgeries.
Methods
A retrospective study was carried out by collecting data from patients undergoing TKA revision for PPI. Patients who did not have sufficient data to confirm or exclude the diagnosis of PJI and insufficient information that did not allow comparison of systems were exclude. An analysis of the variables of the study participants was carried out, the microbiological profile was evaluated and the different diagnostic systems were compared.
Results
A total of 188 participants were included, with 67 cases excluded. At the end, 121 cases of revisions due to chronic infection were analyzed. The average age of patients undergoing revision was 71 years, with the majority being women. The microbiological profile converged with previous literature. MSIS 2018 (standard) identified 39 cases of infection, with 10 (25%) culture-negative cases. The 2013 MSIS diagnosed 35 infections, with 6 (17%) showing no bacterial growth. EBJIS identified 47 cases of infection, of which 20 (38%) were culture-negative cases. Of the cases considered infected by MSIS 2018, all were also considered infected by EBJIS 2021. However, of the 47 cases considered confirmed infection by EBJIS, 39 patients were considered confirmed infection by MSIS 2018, 4 possibly infected and 4 not infected, which makes the european system positive a greater number of cases in addition to confirming more cases without bacterial growth.
Conclusion
EBJIS demonstrated more cases of infection when compared to MSIS 2018 and more inconclusive/possibly infected cases. MSIS 2013 would not change the management of all patients who confirmed infection.