Experimental study of silkworm larvae plasma colorimetry based on immune cascade reaction in accurate diagnosis of periprosthetic joint infection_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Chi ¹ , WANG Yuanhe ² , SUN Kang ² ,  TIAN Shaoqi ²

1. Department of Joint Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai Shandong, 264100, P. R. China;
2. Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P. R. China;

Corresponding author：

TIAN Shaoqi, Email: shaoqi99@aliyun.com

Keywords：

Silkworm larvae plasma colorimetry; periprosthetic joint infection; precise diagnosis

DOI：

10.7507/1002-1892.202109046

Video：

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Objective To investigate the diagnostic efficacy of silkworm larvae plasma (SLP) colorimetry in the accurate diagnosis of periprosthetic joint infection (PJI). Methods Ninety healthy male New Zealand white rabbits were used for knee arthroplasty with Swanson prosthesis. Then they were randomly divided into 3 groups according to different pathogenic bacteria: group A (Staphylococcus aureus group), group B (Staphylococcus epidermidis group) and group C (Escherichia coli group), with 30 rats in each group. The PJI model was prepared by knee injection with 1 mL of pathogenic bacteria of different concentrations. Samples were taken before inoculation and at 7, 14, and 21 days after inoculation, and based on the 2018 PJI Philadelphia International Consensus diagnostic criteria, the success rate of modeling among 3 groups of experimental animals was determined. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic efficiency of SLP colorimetry were calculated. Results At 21 days after inoculation, 26, 18, and 23 rabbits in groups A, B, and C were diagnosed as infection, respectively. The success rates of modeling were 86.7%, 60.0%, and 76.7%, respectively, showing no significant difference among the 3 groups (χ²=5.724, P=0.073). The results of PJI colorimetry showed that 1 false-positive animal (specificity 75.0%) appeared in group A at 7 days, and the specificity of SLP increased to 100.0% over time (on 14 and 21 days); on 14 and 21 days, another animal appeared false-negative results (sensitivity decreased from 100.0% to 96.2%). One false-positive animal appeared in group B at 7 days (specificity 91.7%), the specificity returned to 100.0% over time; 1 and 4 false-negative animals appeared at 14 and 21 days, respectively (sensitivity 94.4% and 83.3%, respectively). In group C, two false-positive animals (specificity 71.4%) were found at 7 days, and then returned to 100.0%. The diagnostic efficiency of groups A and C was very high at 21 days (96.7% and 100.0%), even for the low virulence Staphylococcus epidermidis in group B, the diagnostic efficiency could be maintained at 90.0% (21 days), and the overall diagnostic efficiency was very good (95.6%). Conclusion SLP colorimetry has high sensitivity, specificity, and diagnostic efficiency in the diagnosis of PJI, which is a potential diagnostic method.

Citation： ZHANG Chi, WANG Yuanhe, SUN Kang, TIAN Shaoqi. Experimental study of silkworm larvae plasma colorimetry based on immune cascade reaction in accurate diagnosis of periprosthetic joint infection. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(2): 203-208. doi: 10.7507/1002-1892.202109046 Copy

1.	Yan Q, Karau MJ, Greenwood-Quaintance KE, et al. Comparison of diagnostic accuracy of periprosthetic tissue culture in blood culture bottles to that of prosthesis sonication fluid culture for diagnosis of prosthetic joint infection (PJI) by use of bayesian latent class modeling and IDSA PJI criteria for classification. J Clin Microbiol, 2018, 56(6): e00319-18. doi: 10.1128/JCM.00319-18.
2.	Li Z, Li C, Wang G, et al. Diagnostic accuracy of synovial fluid D-lactate for periprosthetic joint infection: a systematic review and meta-analysis. J Orthop Surg Res, 2021, 16(1): 606. doi: 10.1186/s13018-021-02778-8.
3.	Ashley BS, Parvizi J. Current insights in the evaluation and treatment of infected total knee arthroplasty. J Knee Surg, 2021, 34(13): 1388-1395.
4.	Bettiol P, Egan A, Cox C, et al. Pathological analysis of periprosthetic soft tissue and modes of failure in revision total joint arthroplasty patients. SAGE Open Med, 2021, 9: 20503121211047099. doi: 10.1177/20503121211047099.
5.	Parvizi J, Jacovides C, Zmistowski B, et al. Definition of periprosthetic joint infection: is there a consensus? Clin Orthop Relat Res, 2011, 469(11): 3022-3030.
6.	Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis, 2013, 56(1): e1-e25.
7.	Parvizi J, Tan TL, Goswami K, et al. The 2018 definition of periprosthetic hip and knee infection: An evidence-based and validated criteria. J Arthroplasty, 2018, 33(5): 1309-1314.
8.	Yoshida H, Ochiai M, Ashida M. Beta-1, 3-glucan receptor and peptidoglycan receptor are present as separate entities within insect prophenoloxidase activating system. Biochem Biophys Res Commun, 1986, 141(3): 1177-1184.
9.	周洁, 张稳燕, 孟勇. 静脉注射不同浓度戊巴比妥钠对兔麻醉死亡率的影响. 实验动物科学, 2011, 28(6): 67-68.
10.	丛锐军, 符培亮, 刘伟, 等. 兔关节内植物植入术后金黄色葡萄球菌感染模型的建立. 中华关节外科杂志 (电子版), 2012, 6(6): 920-930.
11.	López-Torres II, Sanz-Ruíz P, Navarro-García F, et al. Experimental reproduction of periprosthetic joint infection: Developing a representative animal model. Knee, 2020, 27(3): 1106-1112.
12.	王勇平, 张怀斌, 谢瑞敏, 等. 新西兰兔全膝关节置换术后假体周围感染模型的建立. 中国实验动物学报, 2021, 29(5): 657-663.
13.	Slullitel PA, Oñativia JI, Buttaro MA, et al. State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty. EFORT Open Rev, 2018, 3(7): 434-441.
14.	马瑞, 王家麟, 吴梦军, 等. 关节置换后假体周围感染病原菌分布及耐药情况与治疗周期的关系. 中国组织工程研究, 2021, 25(3): 380-385.
15.	Schulz P, Dlaska CE, Perka C, et al. Preoperative synovial fluid culture poorly predicts the pathogen causing periprosthetic joint infection. Infection, 2021, 49(3): 427-436.
16.	Ull C, Yilmaz E, Baecker H, et al. Microbial findings and the role of difficult-to-treat pathogens in patients with periprosthetic infection admitted to the intensive care unit. Orthop Rev (Pavia), 2020, 12(3): 8867. doi: 10.4081/or.2020.8867.
17.	Ashida M. A cane sugar factor suppressing activation of prophenoloxidase in haemolymph of the silkworm, Bombyx mori. Insect Biochemistry and Molecular Biology, 1981, 11: 57-65.
18.	Ashida M, Brey PT. Role of the integument in insect defense: pro-phenol oxidase cascade in the cuticular matrix. Proc Natl Acad Sci U S A, 1995, 92(23): 10698-10702.
19.	Tsuchiya M, Asahi N, Suzuoki F, et al. Detection of peptidoglycan and beta-glucan with silkworm larvae plasma test. FEMS Immunol Med Microbiol, 1996, 15(2-3): 129-134.
20.	Proctor RA, von Eiff C, Kahl BC, et al. Small colony variants: a pathogenic form of bacteria that facilitates persistent and recurrent infections. Nat Rev Microbiol, 2006, 4(4): 295-305.
21.	Cyprowski M, Ławniczek-Wałczyk A, Górny RL. Peptidoglycans in cutting fluids-a good indicator of bacterial contamination? Ann Agric Environ Med, 2014, 21(2): 256-258.
22.	Kobayashi T, Tani T, Yokota T, et al. Detection of peptidoglycan in human plasma using the silkworm larvae plasma test. FEMS Immunol Med Microbiol, 2000, 28(1): 49-53.
23.	Inada K, Takahashi K, Ichinohe S, et al. A silkworm larvae plasma test for detecting peptidoglycan in cerebrospinal fluid is useful for the diagnosis of bacterial meningitis. Microbiol Immunol, 2003, 47(10): 701-707.
24.	Shimizu T, Endo Y, Tabata T, et al. Diagnostic and predictive value of the silkworm larvae plasma test for postoperative infection following gastrointestinal surgery. Crit Care Med, 2005, 33(6): 1288-1295.

1. Yan Q, Karau MJ, Greenwood-Quaintance KE, et al. Comparison of diagnostic accuracy of periprosthetic tissue culture in blood culture bottles to that of prosthesis sonication fluid culture for diagnosis of prosthetic joint infection (PJI) by use of bayesian latent class modeling and IDSA PJI criteria for classification. J Clin Microbiol, 2018, 56(6): e00319-18. doi: 10.1128/JCM.00319-18.
2. Li Z, Li C, Wang G, et al. Diagnostic accuracy of synovial fluid D-lactate for periprosthetic joint infection: a systematic review and meta-analysis. J Orthop Surg Res, 2021, 16(1): 606. doi: 10.1186/s13018-021-02778-8.
3. Ashley BS, Parvizi J. Current insights in the evaluation and treatment of infected total knee arthroplasty. J Knee Surg, 2021, 34(13): 1388-1395.
4. Bettiol P, Egan A, Cox C, et al. Pathological analysis of periprosthetic soft tissue and modes of failure in revision total joint arthroplasty patients. SAGE Open Med, 2021, 9: 20503121211047099. doi: 10.1177/20503121211047099.
5. Parvizi J, Jacovides C, Zmistowski B, et al. Definition of periprosthetic joint infection: is there a consensus? Clin Orthop Relat Res, 2011, 469(11): 3022-3030.
6. Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis, 2013, 56(1): e1-e25.
7. Parvizi J, Tan TL, Goswami K, et al. The 2018 definition of periprosthetic hip and knee infection: An evidence-based and validated criteria. J Arthroplasty, 2018, 33(5): 1309-1314.
8. Yoshida H, Ochiai M, Ashida M. Beta-1, 3-glucan receptor and peptidoglycan receptor are present as separate entities within insect prophenoloxidase activating system. Biochem Biophys Res Commun, 1986, 141(3): 1177-1184.
9. 周洁, 张稳燕, 孟勇. 静脉注射不同浓度戊巴比妥钠对兔麻醉死亡率的影响. 实验动物科学, 2011, 28(6): 67-68.
10. 丛锐军, 符培亮, 刘伟, 等. 兔关节内植物植入术后金黄色葡萄球菌感染模型的建立. 中华关节外科杂志 (电子版), 2012, 6(6): 920-930.
11. López-Torres II, Sanz-Ruíz P, Navarro-García F, et al. Experimental reproduction of periprosthetic joint infection: Developing a representative animal model. Knee, 2020, 27(3): 1106-1112.
12. 王勇平, 张怀斌, 谢瑞敏, 等. 新西兰兔全膝关节置换术后假体周围感染模型的建立. 中国实验动物学报, 2021, 29(5): 657-663.
13. Slullitel PA, Oñativia JI, Buttaro MA, et al. State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty. EFORT Open Rev, 2018, 3(7): 434-441.
14. 马瑞, 王家麟, 吴梦军, 等. 关节置换后假体周围感染病原菌分布及耐药情况与治疗周期的关系. 中国组织工程研究, 2021, 25(3): 380-385.
15. Schulz P, Dlaska CE, Perka C, et al. Preoperative synovial fluid culture poorly predicts the pathogen causing periprosthetic joint infection. Infection, 2021, 49(3): 427-436.
16. Ull C, Yilmaz E, Baecker H, et al. Microbial findings and the role of difficult-to-treat pathogens in patients with periprosthetic infection admitted to the intensive care unit. Orthop Rev (Pavia), 2020, 12(3): 8867. doi: 10.4081/or.2020.8867.
17. Ashida M. A cane sugar factor suppressing activation of prophenoloxidase in haemolymph of the silkworm, Bombyx mori. Insect Biochemistry and Molecular Biology, 1981, 11: 57-65.
18. Ashida M, Brey PT. Role of the integument in insect defense: pro-phenol oxidase cascade in the cuticular matrix. Proc Natl Acad Sci U S A, 1995, 92(23): 10698-10702.
19. Tsuchiya M, Asahi N, Suzuoki F, et al. Detection of peptidoglycan and beta-glucan with silkworm larvae plasma test. FEMS Immunol Med Microbiol, 1996, 15(2-3): 129-134.
20. Proctor RA, von Eiff C, Kahl BC, et al. Small colony variants: a pathogenic form of bacteria that facilitates persistent and recurrent infections. Nat Rev Microbiol, 2006, 4(4): 295-305.
21. Cyprowski M, Ławniczek-Wałczyk A, Górny RL. Peptidoglycans in cutting fluids-a good indicator of bacterial contamination? Ann Agric Environ Med, 2014, 21(2): 256-258.
22. Kobayashi T, Tani T, Yokota T, et al. Detection of peptidoglycan in human plasma using the silkworm larvae plasma test. FEMS Immunol Med Microbiol, 2000, 28(1): 49-53.
23. Inada K, Takahashi K, Ichinohe S, et al. A silkworm larvae plasma test for detecting peptidoglycan in cerebrospinal fluid is useful for the diagnosis of bacterial meningitis. Microbiol Immunol, 2003, 47(10): 701-707.
24. Shimizu T, Endo Y, Tabata T, et al. Diagnostic and predictive value of the silkworm larvae plasma test for postoperative infection following gastrointestinal surgery. Crit Care Med, 2005, 33(6): 1288-1295.

Chinese Journal of Reparative and Reconstructive Surgery

Experimental study of silkworm larvae plasma colorimetry based on immune cascade reaction in accurate diagnosis of periprosthetic joint infection

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