Abstract
Orthopedic prosthesis infection must be medically managed after appropriate microbiological documentation. While bacteria and fungi are acknowledged to be causative opportunistic pathogens in this situation, the potential role of methanogens in orthopedic prosthesis infections is still unknown. In a retrospective study, a total of 100 joint and bone samples collected from 25 patients were screened by specific PCR assays for the detection of methanogens. PCR-positive samples were observed by autofluorescence, electron microscopy and tentatively cultured under specific culture conditions. Methanogens were detected by quantitative PCR in 4/100 samples, in the presence of negative controls. Sequencing identified Methanobrevibacter oralis in two cases, Methanobrevibacter smithii in one case and Methanobrevibacter wolinii in one case. Microscopic methods confirmed molecular findings and bacterial culture yielded two strains of Staphylococcus aureus, one strain of Staphylococcus epidermidis and one strain of Proteus mirabilis. These unprecedented data highlight the presence of methanogens in joint and bone samples of patients also diagnosed with bacterial orthopedic prosthesis infection, questioning the role of methanogens as additional opportunistic co-pathogens in this situation.
Highlights
Postoperative infection is the principal complication of orthopedic prosthesis implantation, with an estimated prevalence of 0.5 to 1% after hip prosthesis implantation and 1 to 2% after knee prosthesis implantation [1,2,3]
Of the 100 joint fluid and bone samples investigated for the presence of methanogens, four samples (4/100) collected from four different patients were found to be positive in both screening real-time PCR analyses and confirmatory standard PCR
The 16S rRNA gene amplicon sequencing identified Methanobrevibacter oralis in two cases, Methanobrevibacter smithii in one case and Methanobrevibacter wolinii in one case
Summary
Postoperative infection is the principal complication of orthopedic prosthesis implantation, with an estimated prevalence of 0.5 to 1% after hip prosthesis implantation and 1 to 2% after knee prosthesis implantation [1,2,3]. Documentation of orthopedic prosthesis infection relies on microbiological investigations including direct microscopic examination of the samples following Gram staining, PCR-based tests, and culture in an aerobic atmosphere [6,7,8,9]. Microbiological diagnosis of these infections is mandatory, as the antimicrobial susceptibility pattern of the causative opportunistic pathogens guides the medical treatment alongside the surgical orthopedic treatment [10,11,12]. Their dysbiosis is associated with many diseases including severe acute malnutrition, inflammatory bowel diseases and chronic constipation [21,22,23,24,25]
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