How reliable is the next generation of multiplex-PCR for diagnosing prosthetic joint infection compared to the MSIS criteria? Still missing the ideal test

Abstract

Introduction: Identification of the pathogen in case of a periprosthetic joint infection (PJI) remains 1 of the greatest challenges in septic surgery. Rapid germ identification enables timely, specific, antimicrobial therapy. The first multiplex PCR (polymerase chain reaction) generation (Unyvero-i60) enables germ detection within 5 hours with a sensitivity of 78.8% and a specificity of 100%. The aim of this study is to investigate the performance of the new generation of cartridges (Unyvero-ITI) of multiplex PCR in the case of a PJI. Methods: In a prospective study, intraoperatively aspirated synovial fluid from 97 patients with aseptic or septic hip or knee revision surgery (49 aseptic, 48 septic) was examined with the multiplex PCR system (Unyvero-ITI) and the results were compared with the MSIS criteria. In addition, the time until the microbiological result was obtained in the event of a germ detection was documented. Results: The multiplex PCR showed a germ detection with a sensitivity of 85.1% and a specificity of 98.0%. In 7 cases a false negative result was found and in one patient a false positive result was found. The general accuracy of this test procedure was 91.8%. The detection of germs was carried out within 5 hours with the multiplex PCR compared to 4.9 days in conventional microbiological diagnostics. Conclusions: The new generation of multiplex-PCR was able to improve germ detection. The possibility of prompt detection of germs offers the option of faster, targeted antimicrobial therapy. This diagnostic tool offers significant advantages, particularly in the context of an acute periprosthetic infection.

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

“…Recently, we evaluated the second-generation Unyvero ITI cartridge on joint aspirate specimens and demonstrated an improved diagnostic accuracy in comparison to routine cultures, with a sensitivity of 80% 10 . Similarly, Lausmann et al demonstrated an increased performance of the novel Unyvero ITI cartridge when analysing synovial fluid of 97 patients, with a sensitivity of 85% 28 .…”

Synovial fluid calprotectin performs better than synovial fluid polymerase chain reaction and interleukin-6 in the diagnosis of periprosthetic joint infection

“…Synovial polymerase chain reaction studies. Overall, 20 studies described the diagnostic accuracy of synovial fluid PCR in the detection of PJi, using the msis criteria as the standard reference test, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] with baseline characteristics of individual studies shown in table i. three studies contributed to two data points each, as these studies published data on different PCR Fig. 6 Forest plot for synovial fluid calprotectin studies.…”

Predictive Antibiotic Susceptibility Testing by Next-Generation Sequencing for Periprosthetic Joint Infections: Potential and Limitations

“…PCR-based techniques are independent from bacterial culture and operate directly on patient samples, decreasing turn-around times to a few hours [ 15 , 16 ]. Lausmann et al (2020) tested the Unyvero ITI ® PCR cartridge on 97 patients with aseptic or septic, hip or knee revision surgery, and obtained an overall accuracy of 91.8% [ 17 ]. BioFire ® Bone and Joint Infection was evaluated by Graue et al on 1544 patient samples and the obtained overall sensitivity was 90.2% and specificity was 99.8% [ 18 ].…”