Abstract
The rapid detection of etiological agents is important for the successful treatment of iliopsoas abscess (IPA). The purpose of this study was to investigate the clinical utility of a real-time polymerase chain reaction (PCR) that targets the mecA gene for methicillin-resistant staphylococci (MRS) and the 16S rRNA gene for pan-bacteria. Our retrospective diagnostic study included 22 patients exhibiting IPAs and four patients with noninfectious iliopsoas mass regions who underwent computerized tomography or ultrasonography-guided biopsy and/or surgical treatment. Clinical symptoms, serum data, imaging analysis, and tissue microbiological culture were utilized for the diagnosis of IPA. The diagnostic accuracy of real-time PCR was determined based on the diagnosis of IPA and microbiological culture results. The microbiological culture was positive for 12 IPA cases that included 2 MRSA infections. Among 12 culture-positive IPA cases, 16S rRNA-PCR was positive in 12 and MRS-PCR in two. Among 10 culture-negative IPA cases, including 3 TB cases, 16S rRNA-PCR was positive in 8 and MRS-PCR in 2. In noninfectious iliopsoas mass patients, neither 16S rRNA nor MRS-PCR detected bacterial DNA. The sensitivity, specificity, positive predictive, and negative predictive values of 16S rRNA-PCR for diagnosing IPA were 0.91, 1.00, 1.00, and 0.67, respectively, while those for the diagnosis of MRS infection with MRS-PCR were 1.00, 0.92, 1.00, and 0.50, respectively. Real-time PCR targeting bacterial DNA can detect bacterial DNA in culture-negative cases and offer improved detectability of MRS infection in IPA patients.
Highlights
Iliopsoas abscess is a relatively rare disorder that requires emergent diagnosis and extensive antibiotic treatment
The clinical utility of real-time polymerase chain reaction (PCR) targeting Mycobacterium tuberculosis (TB) has been widely documented, diagnosis of other bacteria is still based on microbiological culture, making it difficult to identify the causative organism and rapid and adequate antibiotic treatment [1, 2]
Since real-time PCR has been reported as a useful tool for the diagnosis of infections with viable but nonculturable (VBNC) [6, 7], realtime PCR can improve the diagnostic accuracy of iliopsoas abscess and antibiotic selection
Summary
Iliopsoas abscess is a relatively rare disorder that requires emergent diagnosis and extensive antibiotic treatment. Bacterial culture reportedly shows false-negative results in 25% of patients, which can be attributed to the viable but nonculturable (VBNC) condition of causative bacteria due to prophylactic use of antibiotics and biofilm formation [1]. The clinical utility of real-time polymerase chain reaction (PCR) targeting Mycobacterium tuberculosis (TB) has been widely documented, diagnosis of other bacteria is still based on microbiological culture, making it difficult to identify the causative organism and rapid and adequate antibiotic treatment [1, 2]. If the microbiological culture shows false-negative results, methicillin-resistant staphylococcus(MRS-) targeting antibiotics must be considered in all BioMed Research International iliopsoas abscesses to cover the most likely causative bacteria. Since real-time PCR detects both live and dead bacterial DNA [8, 9], it can detect bacterial DNA in patients with prior initiation of antibiotic treatment
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