Abstract
ABSTRACTProsthetic joint failure is mainly caused by infection, aseptic failure (AF), and mechanical problems. Infection detection has been improved with modified culture methods and molecular diagnostics. However, comparisons between modified and conventional microbiology methods are difficult due to variations in specimen sampling. In this prospective, multidisciplinary study of hip or knee prosthetic failures, we assessed the contributions of different specimen types, extended culture incubations, and 16S rRNA sequencing for diagnosing prosthetic joint infections (PJI). Project specimens included joint fluid (JF), bone biopsy specimens (BB), soft-tissue biopsy specimens (STB), and swabs (SW) from the prosthesis, collected in situ, and sonication fluid collected from prosthetic components (PC). Specimens were cultured for 6 (conventional) or 14 days, and 16S rRNA sequencing was performed at study completion. Of the 156 patients enrolled, 111 underwent 114 surgical revisions (cases) due to indications of either PJI (n = 43) or AF (n = 71). Conventional tissue biopsy cultures confirmed PJI in 28/43 (65%) cases and refuted AF in 3/71 (4%) cases; one case was not evaluable. Based on these results, minor diagnostic adjustments were made. Fourteen-day cultures of JF, STB, and PC specimens confirmed PJI in 39/42 (93%) cases, and 16S rRNA sequencing confirmed PJI in 33/42 (83%) cases. One PJI case was confirmed with 16S rRNA sequencing alone and five with cultures of project specimens alone. These findings indicated that JF, STB, and PC specimen cultures qualified as an optimal diagnostic set. The contribution of sequencing to diagnosis of PJI may depend on patient selection; this hypothesis requires further investigation.
Highlights
Prosthetic joint failure is mainly caused by infection, aseptic failure (AF), and mechanical problems
We found five polymicrobial (5/33; 15%) cases: one displayed Escherichia coli in culture plus S. aureus sequences, one displayed E. faecalis in culture plus Finegoldia magna sequences, one displayed several different species in culture, which were corroborated with sequencing, one displayed Staphylococcus sp. and Corynebacterium sp., and one displayed a combination of Staphylococcus spp.; all confirmed the results obtained in cultures
In this study, we found that results from joint fluid (JF), prosthetic components (PC), and 5-STB set cultures were optimal for the diagnosis of prosthetic joint infections (PJI)
Summary
Prosthetic joint failure is mainly caused by infection, aseptic failure (AF), and mechanical problems. Comparisons between modified and conventional microbiology methods are difficult due to variations in specimen sampling In this prospective, multidisciplinary study of hip or knee prosthetic failures, we assessed the contributions of different specimen types, extended culture incubations, and 16S rRNA sequencing for diagnosing prosthetic joint infections (PJI). One PJI case was confirmed with 16S rRNA sequencing alone and five with cultures of project specimens alone These findings indicated that JF, STB, and PC specimen cultures qualified as an optimal diagnostic set. Culture assays remain the standard for ascertaining a PJI diagnosis; since the late 1990s, molecular diagnostics have gained ground, methods that target 16S rRNA with either multiplex PCR or sequencing strategies [10,11,12]. Several specimen types have been studied extensively [6, 14, 17,18,19,20,21,22,23], only a few studies had a prospective design that implemented criteria for patient selection, sampling of multiple specimen types, and optimized culture methods [24]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
