Diagnostic accuracy of multiplex polymerase chain reaction on tissue biopsies in periprosthetic joint infections

Abstract

The diagnosis and treatment of periprosthetic joint infection (PJI) currently relies on cultures, which are time-consuming and often fail. Multiplex PCR assays promise reliable and prompt results, but have been heterogeneously evaluated. In this study, we analyse multiplex PCR in pathogen identification using only tissue biopsies. 42 patients after revision arthroplasty of the hip or knee were evaluated using multiplex PCR to identify microorganisms. The patients were classified according to the diagnostic criteria published by Zimmerli et al. and the results were compared to the respective microbiological cultures. PJI was detected in 15 patients and 27 revisions were aseptic. The multiplex PCR of tissue biopsies had a sensitivity of 0.3 (95% CI 0.12–0.62), a specificity of 1.0 (0.87–1.0), a positive predictive value of 1.0 (0.48–1.0) and a negative predictive value of 0.73 (0.56–0.86). The diagnostic accuracy of multiplex PCR on tissue biopsy samples is low in comparison to routine microbiological cultures. The evaluation of tissue biopsies using multiplex PCR was prone to false negative results. However, multiplex PCR assays have the advantage of rapid pathogen identification. We therefore recommend further investigation of multiplex PCR in the setting of suspected PJI with a careful choice of specimens.

Diagnostic Performance of a Molecular Assay in Synovial Fluid Targeting Dominant Prosthetic Joint Infection Pathogens

“…These techniques enable rapid and sensitive detection of PJIs [ 34 ], do not suffer from culture contamination, can be useful for detecting uncultured or difficult-to-cultivate bacteria, and can increase the speed, sensitivity, and reliability of clinical diagnosis of causative agents [ 35 ]. However, molecular diagnosis remains susceptible to false-positive and false-negative results, and moreover, it is costly [ 36 , 37 ]. Therefore, a novel, accurate, simple, and convenient molecular diagnostic method for PJIs is required.…”

Clinical applications of metagenomic next-generation sequencing in the identification of pathogens in periprosthetic joint infections: a retrospective study

“…In recent years, molecular diagnostic techniques have been widely used in the diagnosis of PJI due to their speed, avoidance of antibiotic interference, and minimal sample requirements. However, these techniques, such as multiplex polymerase chain reaction (PCR) and 16S rRNA gene sequencing [ 9 , 10 ], can only identify a limited number of microorganisms and potentially miss some uncommon pathogens or even fail to detect fungal or polymicrobial infections. Additionally, while matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been widely used in clinical bacterial identification, this method is primarily used for the identification of cultured strains.…”

The Assessment of Multiplex PCR in Identifying Bacterial Infections in Patients Hospitalized with SARS-CoV-2 Infection: A Systematic Review

“…This particular variation of PCR has shown promising results in a variety of DNA testing applications [ 22 , 23 , 24 ]. Multiplex polymerase chain reaction is a faster variation of the conventional polymerase chain reaction (PCR), and differs from it by amplifying more than one target sequence by employing multiple pairs of primers [ 25 , 26 ]. Real-time or reverse transcription PCR (RT-PCR) is also less time-consuming than the conventional PCR by having no post-amplification procedure and being able to detect genetic material from RNA as well.…”