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International Consensus Meeting definition for infection yielded poor accuracy

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International Consensus Meeting definition for infection yielded poor accuracy


August 24, 2022

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Source/Disclosures

Source:

Pannu TS, et al. Paper 1006. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 5-6, 2022; Pittsburgh (hybrid meeting).


Disclosures:
Higuera-Rueda reports no relevant financial disclosures.


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Results from the Musculoskeletal Infection Society Annual Meeting showed the 2018 International Consensus Meeting definition for periprosthetic joint infection had poor accuracy in identifying reimplantations that did or did not fail.

“Overall, we believe that there is a lack of understanding and characterization in inflammatory response on spacers and, because of that, we need better diagnostic tools to evaluate infection control and, therefore, successful reimplantation,” Carlos A. Higuera-Rueda, MD, orthopedic surgeon at Cleveland Clinic Florida, said in a video interview with Healio.

Higuera-Rueda and colleagues retrospectively reviewed data for 123 two-stage revisions for hip (n=49) or knee (n=74) indicated for the treatment of periprosthetic joint infection between 2014 and 2020. Researchers categorized patients into groups based on whether they were positive or negative based on the 2018 International Consensus Meeting (ICM) definition.

“The outcome of reimplantation was defined using the [Musculoskeletal Infection Society] MSIS outcome reporting tool that included MSIS tier one and two, meaning an infection controlled with or without antibiotics, for a total of 81 patients, and MSIS tier three and four, which was a failure [and] means an aseptic or septic revision or death, for a total of 42 patients,” Higuera-Rueda said. “Out of those 42 patients, nine, unfortunately, died.”

Researchers also measured sensitivity, specificity, and positive and negative predictive values with receiver operating characteristic curves and Kaplan-Meier survival analysis.

Although the 2018 ICM definition had a sensitivity of 16% and a positive predictive value of 44%, Higuera-Rueda noted it had a specificity of 89% to determine infection control before reimplantation.

“These give us an area under the curve of only 0.4, showing no ability at all to differentiate success or failure using the MSIS tier instrument,” Higuera-Rueda said. “On the survival analysis, there were no significant differences in failure-free survival between ICM-positive and ICM-negative groups, 33 months vs. 46 months.”