Table 3 Subgroup analysis of sonication fluid cultures for PJI diagnosis
Subgroup analyses | No. of studies | No. of joints | Estimates (95% CI) | |||||
|---|---|---|---|---|---|---|---|---|
Sensitivity | Specificity | PLR | NLR | AUC | DOR | |||
Overall studies | 38 | 6302 | 0.77 (0.76–0.79) | 0.96 (0.95–0.96) | 18.68 (11.92–29.28) | 0.24 (0.21–0.29) | 0.92 (0.89–0.94) | 85.65 (56.46–129.94) |
Study design | ||||||||
Prospective | 19 | 3081 | 0.78 (0.76–0.81) | 0.97 (0.96–0.98) | 28.46 (11.99–67.57) | 0.23 (0.18–0.29) | 0.91 (0.89–0.93) | 134.96 (58.53–311.20) |
Retrospective | 17 | 3068 | 0.76 (0.74–0.79) | 0.95 (0.94–0.96) | 15.57 (9.85–24.61) | 0.25 (0.20–0.32) | 0.94 (0.91–0.95) | 71.85 (47.96–107.65) |
Sample site(s) | ||||||||
H, K, S, E or A | 7 | 1093 | 0.74 (0.70–0.78) | 1.00 (0.99–1.00) | 114.20 (43.84–297.47) | 0.25 (0.21–0.29) | 0.99 (0.99–1.00) | 386.56 (18.6–1077.46) |
H, K, S | 4 | 698 | 0.78 (0.74–0.82) | 0.88 (0.84–0.91) | 7.54 (5.40–1.54) | 0.23 (0.19–0.28) | 0.92 (0.90–0.94) | 52.23 (29.86–91.34) |
H, K | 18 | 3818 | 0.79 (0.76–0.81) | 0.97 (0.96–0.97) | 19.32 (10.71–34.87) | 0.22 (0.17–0.29) | 0.93 (0.90–0.95) | 98.18 (52.62–183.16) |
H or K or S | 8 | 617 | 0.76 (0.70–0.81) | 0.91 (0.88–0.93) | 7.41 (5.46–10.05) | 0.27 (0.21–0.34) | 0.87 (0.84–0.90) | 34.76 (20.72–58.32) |
Publication year | ||||||||
 ≥ 2014 | 27 | 4465 | 0.78 (0.76–0.80) | 0.96 (0.95–0.96) | 18.55 (10.88–31.62) | 0.23 (0.18–0.29) | 0.92 (0.90–0.94) | 89.08 (51.92–152.86) |
 < 2014 | 11 | 1837 | 0.75 (0.71–0.78) | 0.96 (0.95–0.97) | 19.50 (7.70–49.43) | 0.28(0.24–0.32) | 0.87(0.84–0.90) | 81.62 (43.84–151.95) |
Cutoff value | ||||||||
50 CFU/ml | 10 | 1651 | 0.76 (0.72–0.79) | 0.96 (0.95–0.97) | 21.44 (9.90–46.42) | 0.26 (0.17–0.40) | 0.94 (0.92–0.96) | 91.26 (42.43–196.31) |
20 CFU/plate | 6 | 1345 | 0.78 (0.74–0.82) | 0.99 (0.98–1.00) | 62.89 (34.98–113.07) | 0.22 (0.18–0.27) | 0.97 (0.95–0.98) | 247.74 (129.61–473.53) |
20 CFU/ml | 2 | 93 | 0.75 (0.61–0.86) | 0.95 (0.83–0.99) | 9.97 (2.91–34.16) | 0.23 (0.04–1.26) | 0.50 (0.47–0.55) | 49.03 (3.31–725.31) |
5 CFU/plate | 3 | 466 | 0.78 (0.71–0.85) | 0.96 (0.94–0.98) | 15.09 (2.41–94.53) | 0.24 (0.16–0.35) | 0.94 (0.91–0.96) | 87.74 (21.74–354.16) |
2 CFU/ml | 2 | 595 | 0.73 (0.67–0.79) | 0.99 (0.97–1.00) | 50.31 (21.24–119.15) | 0.27 (0.22–0.34) | 0.50 (0.49–0.52) | 185.54 (74.48–462.16) |
Number (joints) | ||||||||
 ≥ 100 | 21 | 5193 | 0.77 (0.75–0.79) | 0.97 (0.96–0.97) | 31.99 (16.64–61.49) | 0.23 (0.19–0.29) | 0.94 (0.91–0.95) | 139.61 (79.32–245.72) |
 < 100 | 17 | 1109 | 0.78 (0.74–0.81) | 0.91 (0.88–0.93) | 7.93 (6.18–10.17) | 0.25 (0.21–0.30) | 0.87 (0.84–0.90) | 37.86 (25.60–55.98) |
Antibiotic use before revision | ||||||||
Yes | 19 | 3799 | 0.79 (0.76–0.81) | 0.97 (0.96–0.98) | 31.24 (17.62–55.40) | 0.23 (0.19–0.28) | 0.93 (0.91–0.95) | 132.06 (81.46–214.07) |
No | 13 | 1825 | 0.74 (0.71–0.77) | 0.94 (0.92–0.95) | 11.07 (5.28–23.24) | 0.27 (0.19–0.38) | 0.91 (0.88–0.93) | 48.79 (21.16–112.50) |
Sample processing time (after prosthesis removal) | ||||||||
Within 6 h | 21 | 2794 | 0.75 (0.73–0.78) | 0.95 (0.94–0.96) | 15.09 (8.29–27.48) | 0.25 (0.20–0.32) | 0.92 (0.90–0.94) | 66.01 (36.77–118.51) |
Within 24–48 h | 3 | 431 | 0.70 (0.64–0.76) | 0.98 (0.95–0.99) | 29.62 (11.44–76.71) | 0.30 (0.25–0.37) | 0.80 (0.78–0.83) | 97.88 (35.62–268.93) |
Patient enrollment | ||||||||
Consecutive | 34 | 5742 | 0.77 (0.75–0.79) | 0.96 (0.95–0.97) | 19.16 (12.11–30.33) | 0.24 (0.20–0.29) | 0.92 (0.89–0.94) | 87.67 (55.86–137.60) |
NA (Not provided) | 4 | 560 | 0.79 (0.72–0.85) | 0.94 (0.91–0.96) | 11.14 (7.66–16.20) | 0.22 (0.17–0.30) | 0.87 (0.84–0.90) | 78.00 (36.93–164.74) |
Solution for prosthesis | ||||||||
Ringer’s solution | 23 | 4342 | 0.79 (0.77–0.81) | 0.95 (0.94–0.96) | 16.79 (9.57–29.48) | 0.23 (0.18–0.29) | 0.92 (0.90–0.94) | 81.45 (47.75–138.95) |
sterile saline | 8 | 622 | 0.74 (0.68–0.79) | 0.93 (0.90–0.96) | 9.94 (5.17–19.10) | 0.26 (0.18–0.38) | 0.92 (0.89–0.94) | 45.82 (20.80–100.93) |
Thioglycolate broth | 3 | 452 | 0.73 (0.65–0.81) | 0.99 (0.98–1.00) | 96.22 (27.43–337.50) | 0.27 (0.20–0.36) | 0.99 (0.99–1.00) | 330.02 (91.33–1192.51) |
Centrifugation | ||||||||
Yes | 24 | 4440 | 0.78 (0.76–0.80) | 0.96 (0.95–0.97) | 20.64 (11.67–36.49) | 0.23 (0.18–0.28) | 0.93 (0.90–0.95) | 95.53 (56.83–160.59) |
No | 11 | 1252 | 0.74 (0.70–0.78) | 0.93 (0.91–0.95) | 12.21 (5.68–26.25) | 0.28 (0.21–0.37) | 0.89 (0.86–0.91) | 53.34 (25.25–112.72) |
Vortexing | ||||||||
Yes | 32 | 5261 | 0.78 (0.76–0.80) | 0.96 (0.95–0.97) | 19.08 (11.96–30.46) | 0.24 (0.20–0.29) | 0.92 (0.90–0.94) | 87.14 (55.07–137.87) |
No | 3 | 431 | 0.73 (0.67–0.79) | 0.87 (0.82–0.91) | 7.48 (1.40–40.02) | 0.29 (0.22–0.38) | 0.91 (0.89–0.92) | 36.54 (11.83–112.90) |
Culture period | ||||||||
Aerobic and anaerobic (≦7d) | 10 | 2045 | 0.73 (0.69–0.76) | 0.98 (0.97–0.99) | 33.41 (14.41–77.47) | 0.27 (0.20–0.37) | 0.93 (0.91–0.95) | 125.03 (54.46–287.03) |
Aerobic (≦7d) and anaerobic (7-14d) | 15 | 2732 | 0.81 (0.79–0.84) | 0.96 (0.95–0.97) | 21.01 (10.93–40.39) | 0.21 (0.16–0.27) | 0.93 (0.91–0.95) | 107.69 (54.11–214.32) |
Aerobic and anaerobic (7-14d) | 10 | 915 | 0.75 (0.71–0.80) | 0.88 (0.85–0.91) | 6.81 (3.80–12.20) | 0.26 (0.18–0.37) | 0.90 (0.87–0.92) | 34.90 (19.12–63.70) |
Reference standard | ||||||||
MSIS or ICM | 13 | 0.81 (0.78–0.84) | 0.94 (0.93–0.96) | 12.41 (7.67–20.06) | 0.21 (0.14–0.31) | 0.94 (0.92–0.96) | 68.58 (39.56–118.89) | |
IDSA or EBJIS | 6 | 0.73 (0.69–0.77) | 0.99 (0.98–1.00) | 38.49 (17.73–83.54) | 0.26 (0.19–0.37) | 0.80 (0.77–0.83) | 170.30 (61.47–471.82) | |
Other | 19 | 0.77 (0.74–0.79) | 0.95 (0.95–0.97) | 20.17 (9.37–43.42) | 0.26 (0.22–0.31) | 0.87 (0.84–0.90) | 87.12 (43.37–175.01) | |
Geographical location | ||||||||
USA | 9 | 0.78 (0.74–0.81) | 0.96 (0.95–0.97) | 20.96 (11.04–39.78) | 0.25 (0.19–0.34) | 0.94 (0.92–0.96) | 93.09 (51.04–169.78) | |
Europe | 25 | 0.77 (0.75–0.79) | 0.95 (0.94–0.96) | 17.36 (9.74–30.94) | 0.24 (0.19–0.30) | 0.92 (0.89–0.94) | 82.68 (46.95–145.59) | |
Asian | 4 | 0.78 (0.72–0.84) | 0.99 (0.96–1.00) | 29.65 (4.37–201.33) | 0.24 (0.17–0.34) | 0.92 (0.89–0.94) | 140.81 (25.88–766.17) | |