Multiplex PCR of sonication fluid accurately differentiates between prosthetic joint infection and aseptic failure

Portillo, María Eugenia; Salvadó, Margarita; Sorlí, Lluïsa; Alier, Albert; Martínez, Santos; Trampuž, Andrej; Gómez, Julia M. Martínez; Puig, Lluís; Horcajada, Juan Pablo

doi:10.1016/j.jinf.2012.08.018

Cited by 149 publications

(122 citation statements)

References 28 publications

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“…However, culture has limited sensitivity especially due to prior antimicrobial use, and its specificity is impaired by contaminating microorganisms of the skin which are often indistinguishable from true pathogens in this setting. Several technical advances have broadened the diagnostic options in recent years [6,[14][15][16]. Here, we report on a pilot study comparing conventional tissue culture with two PCRbased methods using prospectively collected tissue samples from patients with either septic or aseptic prosthetic joint replacements or revisions.…”

Section: Discussionmentioning

confidence: 99%

“…Almost no data are available on the role of multiplex-PCR assays for periprosthetic tissue samples. Using multiplex-PCR of sonication fluid, sensitivity (96 %) and specificity (100 %) for diagnosing PJI could be further improved and might help to differentiate between the clinical conditions of aseptic failure and PJI [15,16]. However, the sophisticated infrastructure to obtain and process sonication fluids is not widely accessible, especially for endoprosthetic departments with external microbiological laboratories.…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of prosthetic joint infections using UMD-Universal Kit and the automated multiplex-PCR Unyvero i60 ITI® cartridge system: a pilot study

et al. 2015

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cultures of periprosthetic tissue samples were compared with the results of broad-range 16S rRNA gene real-time PCR (UMD-Universal Pathogen DNA Extraction and PCR Analysis, Molzym GmbH, Germany) and the multiplex-PCR Unyvero ITI ® cartridge system (U-ITI; Curetis AG, Germany). Conventional culture and broad-range 16S rRNA gene real-time PCR were performed on all samples. U-ITI was used in a subgroup of 28 cases including all culture-positive cases. The agreement of the results from the methods was assessed. Results Of 54 cases, seven were culture-positive. Broadrange 16S rRNA gene real-time PCR gave 6, U-ITI 3 concordant positive results. Of the 47 culture-negative samples, 46 were also negative by broad-range 16S rRNA gene realtime PCR resulting in a 96 % (52/54) agreement between 16S rRNA gene PCR and culture. Of the 21 culture-negative samples analysed with U-ITI, 20 gave negative results, including the single 16S rRNA gene PCR-positive/culturenegative specimen. The rate of agreement between U-ITI and culture results was 82 % (23/28). Conclusion This pilot study gave no indication of superiority of the used NAATs over conventional culture methods for the microbiological diagnosis of PJI. Drawbacks are susceptibility to contamination in the case of 16S rRNA gene real-time PCR, labour-intensive DNA extraction and limited pathogen panel in the case of the multiplex cartridge PCR system. More prospective trials are needed to evaluate the diagnostic performance of NAATs and their impact on the clinical management of PJI. Keywords

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnosis of prosthetic joint infections using UMD-Universal Kit and the automated multiplex-PCR Unyvero i60 ITI® cartridge system: a pilot study

et al. 2015

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“…Cultures were incubated at 378 C for 7 days (aerobically) or 14 days (anaerobically) and inspected daily for microbial growth. Real-time multiplex PCR (SeptiFast Ó ; Roche Diagnostics, San Cugat del Vallès, Barcelona) was performed in sonication fluid of aseptic failure cases, as previously described [21,22].…”

Section: Methodsmentioning

confidence: 99%

Prosthesis Failure Within 2 Years of Implantation Is Highly Predictive of Infection

Portillo¹,

Salvadó²,

Alier

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background The outcome of revision surgery depends on accurate determination of the cause of prosthesis failure because treatment differs profoundly among aseptic loosening, mechanical failure, and prosthetic joint infections (PJI). Questions/purposes We sought to determine (1) the predictive role of the interval from primary to revision surgery in determining the reason for prosthesis failure of a hip, knee, shoulder, or elbow arthroplasty, and (2) whether positive cultures during revision surgery for aseptic loosening were associated with shorter event-free survival of the prosthesis.

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“…PCR techniques have demonstrated beneficial diagnostic value for diagnosing PJI; compared to intraoperative tissue culture, they theoretically have higher sensitivities and shorter turnaround times and are not as affected by treatment (6,10,14,15,21,35). However, differences in sample types analyzed by PCR may influence the diagnostic accuracy.…”

mentioning

confidence: 99%

“…However, differences in sample types analyzed by PCR may influence the diagnostic accuracy. Sonication prosthetic fluid samples may offer additional insight for improving the diagnostic accuracy of PCRs (6,10,14,15,21,35). We previously performed a metaanalysis to evaluate PCR assays for diagnosing PJI (6).…”

mentioning

confidence: 99%

Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

Zhai

Qin

et al. 2014

J Clin Microbiol

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bThis meta-analysis included 12 studies that evaluated sonication fluid cultures (SFC) for the diagnosis of prosthetic joint infection (PJI). The pooled sensitivity and specificity were 0.80 (95% confidence interval [CI], 0.74 to 0.84) and 0.95 (CI, 0.90 to 0.98), respectively. Subgroup analyses showed that a 14-day anaerobic culture may improve sensitivity, the use of centrifugation or vortexing may improve specificity, and the use of 400 to 500 ml of Ringer's solution for containers may improve sensitivity and specificity. The best SFC cutoff was >5 CFU. In conclusion, SFC has high sensitivity and very high specificity for diagnosing PJI. P rosthetic joint infection (PJI), which occurs in 1 to 12% of surgical cases, is a common catastrophic complication of joint replacement (1-3). Hence, distinguishing PJI from other causes of joint failure, such as metal allergy or aseptic loosening, is important (4). Several tests for diagnosing PJI, including laboratory tests, nuclear medicine detection, rapid molecular tests, histopathology, and microbiologic culture (5-7), have limited sensitivity and specificity, which impedes the differentiation of PJI from other prosthetic failures (3,4,8).Sonication fluid cultures (SFC), which use sonication to dislodge bacteria from the prosthetic surface, have shown promising improvements in sensitivity compared with that for traditional tissue cultures (9). However, the sensitivities (range, 0.67 to 0.91) and specificities (range, 0.72 to 1.0) among studies assessing the diagnostic value of SFC for PJI are inconsistent (9-21). The Infectious Diseases Society of America guidelines suggest a gap in the validation of the diagnostic value of SFC for PJI and request additional higher-level evidence (8). Therefore, we evaluated the detection validity of SFC for PJI to provide further evidence for its clinical use.We searched Medline, EMBASE, and OVID for articles published between January 1990 and August 2013, using the following medical subject headings or free-text words: joint prosthesis, prosthesis infection, septic loosening, aseptic loosening, replacement, or arthroplasty; and sonication, sonicate, or ultrasonicate. We also manually searched the reference lists of eligible studies

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Multiplex PCR of sonication fluid accurately differentiates between prosthetic joint infection and aseptic failure

Cited by 149 publications

References 28 publications

Diagnosis of prosthetic joint infections using UMD-Universal Kit and the automated multiplex-PCR Unyvero i60 ITI® cartridge system: a pilot study

Diagnosis of prosthetic joint infections using UMD-Universal Kit and the automated multiplex-PCR Unyvero i60 ITI® cartridge system: a pilot study

Prosthesis Failure Within 2 Years of Implantation Is Highly Predictive of Infection

Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

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