Molecular techniques for diagnosing prosthetic joint infections

Abstract

Prosthetic joint infections (PJI) can be broadly classed into two groups: those where there is a strong clinical suspicion of infection and those with clinical uncertainty, including 'aseptic loosening'. Confirmation of infection and identification of the causative organism along with provision of antibiotic susceptibility data are important stages in the management of PJI. Conventional microbiological culture and susceptibility testing is usually sufficient to provide this. However, it may fail due to prior antimicrobial treatment or the presence of unusual and fastidious organisms. Molecular techniques, in particular specific real-time and broad-range PCR, are available for diagnostic use in suspected PJI. In this review, we describe the techniques available, their current strengths, limitations and future development. Real-time pathogen-specific and broad-range PCR (with single sequence determination) are suitable for use as part of the routine diagnostic algorithm for clinically suspected PJI. Further development of broad-range PCR with high-throughput (next-generation) sequencing is necessary to understand the microbiome of the prosthetic joint further before this technique can be used for routine diagnostics in clinically unsuspected PJI, including aseptic loosening.

Preclinical Evaluation of Photoacoustic Imaging as a Novel Noninvasive Approach to Detect an Orthopaedic Implant Infection

“…For synovial fluid markers, alpha-defensin has shown high specificity and sensitivity for PJI 20 , but aspiration in general is invasive and not without complication. Polymerase chain reaction (PCR) of synovial fluid may improve sensitivity and specificity of detection but in turn is potentially concerning for high false positive rates from contamination 21 and also is invasive. Nuclear medicine studies such as 67 Gallium, 111 In labelled leukocyte scintigraphy, 99 Tc-bone scintigraphy, and 18 FDG-PET-imaging have successfully diagnosed PJI 22–26 , but this technology exposes patients to substantial doses of radiation.…”

CORR Insights®: Length of Endoprosthetic Reconstruction in Revision Knee Arthroplasty Is Associated With Complications and Reoperations

“…The recent development of clinically-available tests for synovial alpha defensin and C-reactive protein provide one means of more clearly and reliably screening for occult infection in patients such as this with high-risk histories or elevated preoperative inflammatory markers [3]. Polymerase chain reaction-based techniques offer further promise, but additional work is needed to limit false-positives due to either contamination or coincidental findings [4].…”

From Bench to Bedside: Alpha-defensin—The Biggest Thing in Joint Replacement Infections Since Prophylactic Antibiotics?

“…For example, polymerase chain reaction-based techniques can be limited by both contamination and coincidental findings-a positive finding unfortunately does not necessarily correlate with clinical relevance [9].…”