16S rRNA Real-Time reverse transcription PCR in synovial fluid for diagnosis of periprosthetic joint infection

Abstract

Objective To investigate the efficiency of 16S rRNA Real-time reverse transcription PCR technique in the diagnosis of periprosthetic joint infection, and compare its sensitivity and specificity with conventional culture. Methods There were 43 revision cases from July 2013 to December 2015. Synovial fluid collected by puncture preoperatively, tissues from five different parts around the prosthesis collected intra-operatively were cultured by blood plate and BacT/Alert FN respectively. The 16S rRNA in interface membrane was detected by real-time reverse transcription PCR as a marker to diagnose PJI. At the same time, the synovial fluid was routinely bacterial cultured. We compared the sensitivity and specificity of two methods. Results There are 22 THAs and 21 TKAs respectively in 43 cases, 23 cases diagnosed prosthetic joint infection and 20 cases diagnosed non prosthetic joint infection. The sensitivity of 16S rRNA Real-time reverse transcription PCR is higher than the conventional bacterial culture (78.2% vs. 47.8%). There was no difference in the specificity and PPV and NPV. For PCR in prosthetic joint infection group, Staphylococcus epidermidis in 5 cases, Staphylococcus aureus in 3 cases, streptococcus in 4 cases, E.coli in 2 cases, Staphylococcus lugdunensis, Pseudomonas aeruginosa, Staphylococcus haemolyticus and Mycoplasma in 1 case respectively. For culture in prosthetic joint infection group, Staphylococcus epidermidis in 5 cases, Staphylococcus aureus in 2 cases, Staphylococcus lugdunensis, Pseudomonas aeruginosa, Staphylococcus haemolyticus and E.coli in 1 case respectively. For non prosthetic joint infection group, PCR and culture are all negative. Conclusion The sensitivity of 16S rRNA Real-time reverse transcription PCR is higher than the conventional bacterial culture. Key words: Arthroplasty, replacement, hip; Arthroplasty, replacement, knee; Infection; Reverse transcriptase polymerase chainreaction