Abstract
In the past, various efforts have been made to investigate diagnostic tools for periprosthetic-joint-infection (PJI). It is little-known about the diagnostic utility of polymerase-chain-reaction (PCR) in this context, especially concerning the role of multiplex-PCR assays comparing with conventional tissue culture. Evaluation of an automated-multiplex-PCR cartridge system for patients with suspicion of PJI in comparison with conventional microbiological culture and 16S-rDNA-PCR. On suspicion of PJI synovial fluid specimen were taken preoperatively or periprosthetic tissue was collected intraoperatively. Microbiological analysis included conventional culture, 16S-rDNA-PCR and automated-multiplex-PCR (Unyvero-i60-ITI®). The European-Bone-and-Joint-Infection-Society (EBJIS) criteria were used for PJI diagnosis. Positive and negative percent agreement was calculated. Total percentage agreement and Cohen's kappa coefficient were calculated. Sensitivity, specificity and positive predictive value of conventional culture, 16S-rDNA-PCR and multiplex-PCR were calculated. Ten specimens of proved PJI were used as control group. Fifty specimen were suitable for culture. 14 (28%) were classified as PJI, 36 (72%) were aseptic. Coagulase-negative staphylococci was the most frequent detected pathogen. Concordance-rate between mPCR and culture results was 75.6% with a Cohen's kappa of 0.28. Concordance-rate between mPCR and 16S-rDNA was 82.9%, Cohen's kappa was 0.13. Concordance analysis between culture results and 16S-rDNA lead to a concordance-rate of 88.9%. Cohen's kappa was calculated with 0.6. With regard to the microbiological culture as reference, sensitivity of the mPCR was 0.33 and specificity was 0.91. Sensitivity and specificity of the 16S-rDNA-PCR was 0.55 and 0.97. The positive predictive value was 0.57 for the mPCR and 0.83 for the 16S-rDNA-PCR. Due to fair agreement between mPCR and conventional microbiological culture, the tested multiplex-PCR could be an additional instrument for the detection of PJI but is not superior over the conventional culture.
Highlights
Periprosthetic joint infection (PJI) is rare, but still a common and serious cause of failure in total hip- or knee arthroplasty [1, 2]
Due to fair agreement between multiplex PCR (mPCR) and conventional microbiological culture, the tested multiplex-polymerase chain reaction (PCR) could be an additional instrument for the detection of PJI but is not superior over the conventional culture
We inform of our clinical experience comparing the automated multiplex-PCR Unyvero i60 ITI® (Implant and Tissue Infection) cartridge (U-ITI) application (Curetis AG, Holzgerlingen, Germany) with conventional culture and with a 16S rDNA PCR assay in patients with suspected PJI
Summary
Periprosthetic joint infection (PJI) is rare, but still a common and serious cause of failure in total hip- or knee arthroplasty [1, 2] The treating of this serious complication is an economic burden, linked with a prolonged inpatient stay, as well as higher morbidity and mortality [3, 4]. Automated and operable multiplex-PCR systems are evolving for genotyping evaluation of bacteria Advantages of these systems are a quick turnaround time, prompt detection within four to five hours of the typical PJI-relevant pathogens including genotyping resistance patterns and a higher sensitivity in cases of prior use of antibiotics. We inform of our clinical experience comparing the automated multiplex-PCR Unyvero i60 ITI® (Implant and Tissue Infection) cartridge (U-ITI) application (Curetis AG, Holzgerlingen, Germany) with conventional culture and with a 16S rDNA PCR assay in patients with suspected PJI
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