Diagnóstico de laboratorio de infecciones periprotésicas
Resumen
La infección periprotésica es una de las peores complicaciones que pueden acontecer tras la implantación de una prótesis y su frecuencia ha aumentado de forma considerable al dispararse el número de prótesis de rodilla y cadera que se implantan anualmente en todo el mundo. A día de hoy no existe ninguna prueba con un 100% de precisión diagnóstica para descartar la infección periprotésica. Es por ello que en los últimos años han proliferado numerosos test diagnósticos. Entre ellos figuran la determinación de la VSG y la PCR, que constituyen una herramienta de evaluación inicial y deben cuantificarse en todos los pacientes con sospecha de infección. Si la sospecha clínica es alta o se obtiene un valor sugestivo de infección, se debe realizar una artrocentesis y proceder al análisis del líquido sinovial. La tinción de Gram no está recomendada de forma rutinaria. El marcador sérico más respaldado por la evidencia actualmente sería la IL-6 con una sensibilidad y especificidad muy altas. Con respecto a los biomarcadores del líquido sinovial, la alfa-defensina y la esterasa leucocitaria son las más ampliamente reconocidas para su uso.ABSTRACTPeriprosthetic Joint Infection is one of the worst complications that can take place after a joint replacement and its frequency has increased with the rising amount of arthroplasties implanted annually around the world. Nowadays, there is no test with 100% diagnostic accuracy for periprosthetic infection; thus, many diagnostic tests have proliferated in recent years. Among them, ESR and CRP determination are an initial assessment tool and should be quantified in every patient with a suspected infection. When a suggestive value of infection was obtained or with a high clinical suspicion, an arthrocentesis should be performed with analysis of the synovial fluid. Gram staining is not routinely recommended. Currently the most validated serum marker is IL 6 with a very high sensitivity and specificity. About synovial biomarkers, alpha defensin and leukocyte esterase are the most widely recognized for their use.Citas
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