Abstract
PurposeThe aim of this study was to evaluate the pre-operative performance of an automated multiplex PCR (mPCR) system in patients with suspected periprosthetic joint infection (PJI).MethodsUnder sterile conditions, synovial fluid samples from patients with a suspected PJI were collected pre-operatively. One hundred eighty microliter of the aspirate was used for analysis in the mPCR. The remaining joint fluid was sent for microbiological analysis. PJI was diagnosed by using the Musculoskeletal Infection Society (MSIS) criteria. Total percentage agreement and Cohen’s kappa coefficient were calculated to measure overall agreement.ResultsOverall, 90 patients with a suspected PJI were included. Using MSIS criteria, 38 (42%) patients were classified as septic. Total percent agreement between mPCR and synovial fluid culture was 86% with a Cohen’s kappa of 0.68. The mPCR and synovial fluid culture showed sensitivities of 71% and 84%, respectively. Combined evaluation provided an even higher sensitivity of 92%. While Cutibacterium spp. were detected five times by mPCR, it could only be cultured once. A higher detection rate of CoNS by mPCR (n = 7) compared to conventional culture (n = 5) was also demonstrated. In comparison to synovial fluid culture, the mPCR missed Staphylococcus aureus five times.ConclusionWith a moderate agreement between synovial fluid mPCR and culture, the mPCR system could be a useful adjunct in diagnosing a PJI pre-operatively. Due to faster availability of results and a higher detection rate of low-virulent microorganisms, it can complement conventional culture.
Highlights
The pre-operative detection of the causative microorganism(s) and antimicrobial susceptibility is essential for ideal surgical and antibiotic treatment of periprosthetic joint infection (PJI)
We aimed to evaluate the detected pathogens and resistance marker in synovial fluid samples so as to compare the results with those of synovial fluid cultures
Of these 38 patients, at least one microorganism was detected in 27 synovial fluid samples by multiplex polymerase chain reactions (PCR) (mPCR) and in 32 synovial fluid specimens by Synovial fluid (SF) culture (Fisher’s exact test; p = 0.271)
Summary
The pre-operative detection of the causative microorganism(s) and antimicrobial susceptibility is essential for ideal surgical and antibiotic treatment of periprosthetic joint infection (PJI). An accurate and prompt evaluation is crucial for treatment success. Pre-operative-collected synovial fluid cultures represent the method of choice for diagnosing an Currently, attention has been paid to polymerase chain reactions (PCR) for genotypic evaluation of bacteria. These techniques are verified methods in diagnosing infectious diseases in hospitalized patients. Multiplex PCR analysis of periprosthetic tissue or periprosthetic sonicate fluid samples has already been evaluated for diagnosing orthopaedic infections [2,3,4,5]. The great advantages of multiplex PCR systems are the short turnaround time and rapid identification within five
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