Molecular Diagnosis of Prosthetic Joint Infection. A Review of Evidence

Gallo, Jiří; Raška, Milan; Dendis, Miloš; Florschütz, Anthony V.; Kolář, Milan

doi:10.5507/bp.2004.022

Cited by 35 publications

(30 citation statements)

References 73 publications

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“…Over 500,000 joint arthroplasties are performed each year in the United States with an infection rate that ranges from 1 to 5% (7,22). A large number of these prosthetic joint infections can be attributed to Staphylococcus species, both Staphylococcus aureus and coagulase-negative staphylococci.…”

Section: Discussionmentioning

confidence: 99%

Isolation of a Strictly Anaerobic Strain of Staphylococcus epidermidis

Rowlinson¹,

LeBourgeois²,

Ward³

et al. 2006

J Clin Microbiol

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Staphylococcus epidermidis is a well-characterized, nonfastidious, aerobic gram-positive coccus commonly isolated in the clinical microbiology laboratory. Although coagulase-negative staphylococci, including Staphylococcus epidermidis, are often considered a contaminant in the clinical laboratory, an increasing number of reports describe their pathogenesis, in particular in infections of prosthetic devices. This article describes the isolation of a strictly anaerobic strain of Staphylococcus epidermidis in pure culture from the site of an infected prosthetic hip. This isolate was unique in that it grew only under strictly anaerobic conditions. Initially, the isolate was thought to be a known anaerobic gram-positive coccus. However, certain key biochemical and antimicrobial tests performed as part of the standard laboratory identification procedure were not consistent with results expected for any known anaerobic gram-positive coccus; the isolate was catalase positive and metronidazole and penicillin resistant. This isolate was characterized by further biochemical analysis, antimicrobial testing, and nucleic acid sequencing. This paper presents the first documented isolation of a strictly anaerobic Staphylococcus epidermidis strain, confirmed by rpoB gene sequencing.

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Section: Discussionmentioning

confidence: 99%

Isolation of a Strictly Anaerobic Strain of Staphylococcus epidermidis

Rowlinson¹,

LeBourgeois²,

Ward³

et al. 2006

J Clin Microbiol

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“…Results to date have been conflicting, likely due to the various methodologies and specimen types evaluated. While PCR has achieved satisfactory results in tests of prosthesis sonication fluid (19, 21), its value is less clear in tests of synovial fluid.To date, most studies that have evaluated PCR of synovial fluid have been based on detection of the 16S rRNA gene (16)(17)(18)(22)(23)(24)(25)(26)(27). The advantage of this approach is the lack of required specific knowledge of the bacterial group in anticipation of testing (22).…”

mentioning

confidence: 99%

Evaluation of a Genus- and Group-Specific Rapid PCR Assay Panel on Synovial Fluid for Diagnosis of Prosthetic Knee Infection

et al. 2016

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We evaluated a genus-and group-specific PCR assay panel using 284 prosthetic knee synovial fluid samples collected from patients presenting to our institution with implant failure. Using the Musculoskeletal Infection Society diagnostic criteria, 88 and 196 samples were classified as showing prosthetic joint infection (PJI) and aseptic failure (AF), respectively. Sensitivities of the synovial fluid PCR panel and culture were 55.6% and 76.1% (P < 0.001), respectively, and specificities were 91.8% and 97.4% (P ‫؍‬ 0.016), respectively. Among the 70 subjects who had received antibiotics within the month preceding synovial fluid aspiration (48 of whom had PJI), PCR panel and synovial fluid culture sensitivities were 64.5% and 85.4%, respectively (P < 0.0001). In this group, the PCR panel detected Staphylococcus aureus in two culture-negative PJI cases. Overall, the evaluated molecular diagnostic tool had low sensitivity when applied to synovial fluid.A s a result of the increase in joint arthroplasty placement in the recent past, we are witnessing increasing numbers of prosthetic joint infections, creating an economic burden on our health system (1, 2). The diagnosis and management of these infections are complex (3-6), with outcome contingent on detection and identification of the causative microorganism(s) (6, 7). The gold standard, culture of synovial fluid, periprosthetic tissue, and/or the implant itself, has been associated with a range of sensitivities (8-14) and has various turnaround times of up to 2 weeks.In recent years, several nucleic acid amplification tests (e.g., PCR) have been evaluated in an attempt to improve the microbiologic diagnosis of prosthetic joint infection (PJI). The potential benefits of these assays include improved turnaround time compared to culture and increased microbiological detection, especially in the setting of prior antibiotic administration, when culture sensitivity may be low (15-21). Results to date have been conflicting, likely due to the various methodologies and specimen types evaluated. While PCR has achieved satisfactory results in tests of prosthesis sonication fluid (19, 21), its value is less clear in tests of synovial fluid.To date, most studies that have evaluated PCR of synovial fluid have been based on detection of the 16S rRNA gene (16)(17)(18)(22)(23)(24)(25)(26)(27). The advantage of this approach is the lack of required specific knowledge of the bacterial group in anticipation of testing (22). Among the major drawbacks of 16S rRNA-based assays are a requirement for the extra step of DNA sequencing to characterize the detected organism, challenges in detecting multiple organisms in polymicrobial infections, and the potential for false-positive results because of the ubiquity of bacterial DNA in containers and reagents used for testing. Studies have shown various sensitivities and specificities (16,17); while false-positive results are not infrequent (18), lack of amplification due to a small amount of bacterial DNA in synovial fluid is also common (25,27).Our...

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“…Culture-dependent techniques rely on specimen retrieval from periprosthetic tissue followed by inoculation on the appropriate culture media. 12 Because of the previous inadvertent use of antibiotics, sampling errors, inadequate quantities of vital bacteria retrieved, inappropriate transport, or fastidious organisms, as many as 20% of prosthetic joint infection results in being culture negative. 13,14 Yet another reason for culture failure may be the presence of the bacteria within biofilms making them reluctant to grow and inaccessible to antibiotic treatment.…”

mentioning

confidence: 99%

Sonication cultures of explanted components as an add‐on test to routinely conducted microbiological diagnostics improve pathogen detection

Holinka

Bauer

Hirschl

et al. 2010

Journal Orthopaedic Research

142

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The purpose of this study was to improve the pathogen detection in prosthetic joint infections, particularly to evaluate the feasibility of the sonication culture method in the clinical routine. Explanted components of all patients with presumptive prosthetic or implant infection were sonicated separately in sterile containers to dislodge the adherent bacteria from the surfaces and cultured. The results of sonication culture were compared to the conventional tissue culture. We investigated 60 consecutive patients with loosening of the prostheses or implants Forty patients had septic and 20 aseptic loosening (24 knee prostheses, 21 hip prostheses, 6 mega-prostheses, 2 shoulder prostheses, 6 osteosynthesis, 1 spinal instrumentation). The sensitivity of sonication fluid culture was 83.3%, of single positive tissue culture was 72.2% and 61.1% when two or more cultures yielded the same microorganism. In patients receiving antibiotic therapy the sensitivity was 65.9%, 57.5%, and 42.5%, respectively. Pathogens detected in a single tissue culture as well as in sonication culture yielded a significantly higher rate of prosthetic infection than conventional tissue culture alone ( p ¼ 0.008), even in patients receiving continuous antibiotic therapy before explantation ( p ¼ 0.016). The sonication method represents an essential add-on in pathogen detection compared to conventional tissue culture. ß

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Molecular Diagnosis of Prosthetic Joint Infection. A Review of Evidence

Cited by 35 publications

References 73 publications

Isolation of a Strictly Anaerobic Strain of Staphylococcus epidermidis

Isolation of a Strictly Anaerobic Strain of Staphylococcus epidermidis

Evaluation of a Genus- and Group-Specific Rapid PCR Assay Panel on Synovial Fluid for Diagnosis of Prosthetic Knee Infection

Sonication cultures of explanted components as an add‐on test to routinely conducted microbiological diagnostics improve pathogen detection

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