Abstract
BackgroundA major obstacle for the treatment of prosthetic joint infection (PJI) is the identification of the underlying causative organism. While the diagnostic criteria ruling PJI in or out have become ever more accurate, the detection of the causative pathogen(s) still relies mostly on conventional and time-consuming microbial culture. The aim of this study was to evaluate the diagnostic potential of a second-generation multiplex PCR assay (Unyvero ITI G2, Curetis AG, Holzgerlingen, Germany) used on synovial fluid specimens. Our hypothesis was that the method would yield a higher diagnostic accuracy in the pre-operative workup than synovial fluid culture. Thus, a more precise classification of septic and aseptic prosthesis failure could be achieved before revision surgery.MethodsProspectively collected frozen joint fluid specimens from 26 patients undergoing arthroplasty revision surgery of the hip or knee were tested as per the manufacturer’s protocol. Sensitivities, specificities, positive and negative predictive values as well as positive and negative likelihood ratios with corresponding confidence intervals were estimated using the statistical software R. A combination of the serum C-reactive protein (CRP) level, leukocyte count, erythrocyte sedimentation rate, joint fluid culture, tissue biopsy culture, and tissue biopsy histology served as the gold standard.ResultsOf the 26 patients included in the study, 15 were infected and 11 were aseptic. Conventional joint fluid culture showed a sensitivity of 0.67 and a specificity of 0.91. Joint fluid multiplex PCR yielded a sensitivity of 0.8 and a specificity of 1.0.ConclusionsUsing the second-generation Unyvero ITI cartridge on joint fluid aspirate for the detection of prosthetic joint infection, we were able to achieve a higher diagnostic accuracy than with conventional culture. We conclude that to improve pathogen detection before revision surgery, this method represents a valuable and practicable tool.
Highlights
Prosthetic joint infection (PJI) is a serious complication of arthroplasty procedures with devastating consequences for patients and healthcare systems
Most sets of diagnostic criteria rely on the assessment of information gained intra-operatively, such as tissue biopsies, the sonication of explanted components, and histological workup of the synovia-like interface membrane (SLIM) [2, 9,10,11,12,13,14]
Multiplex polymerase chain reaction (PCR) aims to balance this disadvantage by enabling the simultaneous detection of a whole panel of potentially causative organisms [22, 25, 27]
Summary
Prosthetic joint infection (PJI) is a serious complication of arthroplasty procedures with devastating consequences for patients and healthcare systems. The diagnostic process that is set into motion pre-operatively might lack adequate information for a conclusive diagnosis before surgery [10]. Molecular diagnostic methods such as polymerase chain reaction (PCR) have been used in this context [19,20,21]. With this method, the time required to identify the bacterium causing the infection can be reduced considerably. A major obstacle for the treatment of prosthetic joint infection (PJI) is the identification of the underlying causative organism. While the diagnostic criteria ruling PJI in or out have become ever more accurate, the detection of the causative pathogen(s) still relies mostly on conventional and time-consuming microbial culture. A more precise classification of septic and aseptic prosthesis failure could be achieved before revision surgery
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