Detection of Prosthetic Joint Infection Using Synovial Fluid Polymerase Chain Reaction-Electrospray Ionization Mass Spectrometry (original) (raw)
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Diagnosis of Prosthetic Joint Infection by Use of PCR-Electrospray Ionization Mass Spectrometry
Journal of Clinical Microbiology, 2013
We compared PCR-electrospray ionization mass spectrometry (PCR-ESI/MS) to culture using sonicate fluid from 431 subjects with explanted knee ( n = 270) or hip ( n = 161) prostheses. Of these, 152 and 279 subjects had prosthetic joint infection (PJI) and aseptic failure, respectively. The sensitivities for detecting PJI were 77.6% for PCR-ESI/MS and 69.7% for culture ( P = 0.0105). The specificities were 93.5 and 99.3%, respectively ( P = 0.0002).
Journal of Clinical Microbiology and Infectious Diseases
Pathogen identification in prosthetic joint infection is necessary to achieve optimal patient management. The specimens for diagnosis of prosthetic joint infection could be the synovial fluid, the tissue obtained intraoperatively, and the biofilm from the implanted prosthesis. Because of the low sensitivity of the conventional specimen culture method, the preanalytic treatment of the specimen was widely studied to increase the yield of detection. This review aimed to describe the current specimen processing methods used in the clinical setting to increase the pathogen detection rate. A blood culture bottle, tissue homogenization, and explanted prosthesis sonication were the most studied methods with a good result. Molecular methods were also developed to reduce the time of pathogen detection. MALDI-TOF was studied to reduce identification time after a positive culture. Other molecular methods such as polymerase chain reaction and next-generation sequencing were studied to omit the c...
Molecular diagnosis of prosthetic joint infection. a review of evidence
Biomedical Papers, 2004
Prosthetic joint infection (PJI) diagnosis includes several classes of verification. Among them, only a few have a stronger independent value, namely intraarticular purulence and communicating fistulas. Other diagnostic methods require careful test combinations, analysis, and interpretation. Molecular based techniques using the polymerase chain reaction (PCR) seem to be a promising PJI diagnostic modality due to its excellent sensitivity, specificity, positive predictive value, and speed. Most of the recent reviewers are in agreement that molecular diagnosis has enough potential for future application in orthopaedics even if there are only a few heterogeneous studies fully supporting this concept. Conversely, at least one study has been published with significantly worse results (sensitivity and specificity less than 0.75). The lack of supporting evidence in the published studies may be closely related to varying PCR laboratory procedures, inappropriate reference standards, and other methodological shortcomings among research centers. It is not yet justifiable to firmly include molecular methods into the present PJI diagnostic schemes. The orthopaedic community must await the results of well-organized ongoing studies before considering inclusion of molecular diagnostics as a PJI diagnostic method. The aim of this paper was to make a survey of current PJI molecular diagnostic techniques in orhopaedics.
Culture and PCR analysis of joint fluid in the diagnosis of prosthetic joint infection
The new microbiologica, 2008
This prospective study compared PCR and culture techniques in the diagnosis of prosthetic joint infection (PJI). We obtained joint fluid samples (JFS; n=115) from patients who had failed total joint arthroplasty between January 2003 and June 2005; 49 were positive for PJI according to established strict criteria. JFS were analyzed by PCR (n=35; control n=66) or culture (n=46, control n=48). PCR was positive in 71% of PJI cases, resulting in sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and likelihood ratio for positive results as follows: 0.71; 0.97; 0.88; 0.93; 0.87 and 23.6, respectively. Culture was positive in 44% of PJI samples. Corresponding statistics were 0.44; 0.94; 0.69; 0.87; 0.63 and 7.0, respectively. Significantly higher sensitivity, accuracy and negative predictive values were calculated for PCR versus culture, and there was 83% concordance between the results of intraoperative culture and PCR detection of causative bacteria...
Epidemiology and new developments in the diagnosis of prosthetic joint infection
The International Journal of Artificial Organs, 2012
Although prosthetic joint infection (PJI) is a rare event after arthroplasty, it represents a significant complication that is associated with high morbidity, need for complex treatment, and substantial healthcare costs. An accurate and rapid diagnosis of PJI is crucial for treatment success. Current diagnostic methods in PJI are insufficient with 10–30% false-negative cultures. Consequently, there is a need for research and development into new methods aimed at improving diagnostic accuracy and speed of detection. In this article, we review available conventional diagnostic methods for the diagnosis of PJI (laboratory markers, histopathology, synovial fluid and periprosthetic tissue cultures), new diagnostic methods (sonication of implants, specific and multiplex PCR, mass spectrometry) and innovative techniques under development (new laboratory markers, microcalorimetry, electrical method, reverse transcription [RT]-PCR, fluorescence in situ hybridization [FISH], biofilm microscop...
International Journal of Research in Orthopaedics, 2019
Joint replacement surgery is increasing due to its success in decreasing pain and restoring function. Prosthetic joint infections (PJI) is one of the most detrimental complications of the surgery. These infections can either be acute or chronic and can be caused by a variety of organisms. Effective and efficient identification of the cause of infection is vital so that proper treatment can be provided. The use of polymerase chain reaction (PCR) is a possibility for diagnosis and management of PJI with a reduction in the use of incorrect antibiotics. This is due to its ability to quickly diagnosis viral, bacterial, rickettsia, mycobacterial, and protozoal infection in hours. It also has high sensitivity and specificity even with antimicrobial usage and biofilm production. However, more studies need to be done in order to be able to classify it as a possible gold standard.
Infectious diseases (London, England), 2018
Prosthetic joint infection (PJI) is a severe complication of orthopaedic surgery. Preoperative diagnosis, although sometimes difficult, is key to choose the relevant treatment. We conducted a prospective study aimed at evaluating the diagnostic performance of a multiplex serological test for the pre-operative diagnosis of PJI. Blood samples were collected between 1 July 2016 and 31 July 2017 among patients referred for suspected PJI that occurred at least six weeks prior. Infection diagnosis was confirmed using intraoperative bacteriological cultures during prosthetic exchange. Seventy-one patients were included, with a median age of 73 years (interquartile range [IQR]: 66-81) and 40 (56%) were male. Twenty-six patients had aseptic loosening and 45 patients had PJI. Among the latter, median time since the last surgery was 96 weeks (IQR: 20-324). Intraoperative cultures found Staphylococcus spp, Streptococcus spp or both in 39, 5 and 1 patients, respectively. Sensitivity, specificity...
European Journal of Nuclear Medicine and Molecular Imaging
Background For the diagnosis of prosthetic joint infection, real evidence-based guidelines to aid clinicians in choosing the most accurate diagnostic strategy are lacking. Aim and Methods To address this need, we performed a multidisciplinary systematic review of relevant nuclear medicine, radiological, orthopaedic, infectious, and microbiological literature to define the diagnostic accuracy of each diagnostic technique and to address and provide evidence-based answers on uniform statements for each topic that was found to be important to develop a commonly agreed upon diagnostic flowchart. Results and Conclusion The approach used to prepare this set of multidisciplinary guidelines was to define statements of interest and follow the procedure indicated by the Oxford Centre for Evidence-based Medicine (OCEBM).