Prosthetic Joint Infection Diagnosis Using Broad-Range PCR of Biofilms Dislodged from Knee and Hip Arthroplasty Surfaces Using Sonication

Gomez, Eric; Cazanave, Charles; Cunningham, Scott A.; Greenwood‐Quaintance, Kerryl E.; Steckelberg, James M.; Uhl, James R.; Hanssen, Arlen D.; Karau, Melissa J.; Schmidt, Suzannah M.; Osmon, Douglas R.; Berbari, Elie F.; Mandrekar, Jayawant N.; Patel, Robin

doi:10.1128/jcm.00834-12

Cited by 207 publications

(151 citation statements)

References 27 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%

“…The reported findings for different PJI-associated materials indicate a wide range of sensitivity (50-92 %) and specificity (65-94 %) [8][9][10][11][12][13]. Results from a recent study comparing 16S rRNA gene PCR and consecutive sequencing of sonication fluid with culture of synovial aspirates, tissue samples and sonication fluids reports that 16S rRNA gene PCR improved sensitivity [14]. An up-to-date large, prospective multicenter trial on 16S rRNA gene PCR applied to periprosthetic tissue samples showed a lack of sensitivity of this broad-spectrum molecular method (sensitivity 73.3 % and specificity 95.5 %) [8].…”

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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“…Further efforts to decrease the burden of specimen contamination have been advocated in the literature, including taking three or more samples for culture, using clean instruments when obtaining periprosthetic material, and placing specimens directly into sterile containers for transport to the microbiology laboratory [2,21]. Given the difficulties identifying PJI, a wide range of sensitivities (60%-94%) and specificities (81%-100%) has been reported in the literature [2,6,7,10,12,13,15,21,23,25,26]. We found tissue cultures (93% sensitivity, 98% specificity) outperformed swab cultures (70% sensitivity, 89% specificity) for all measured parameters.…”

Section: Discussionmentioning

confidence: 99%

Swab Cultures Are Not As Effective As Tissue Cultures for Diagnosis of Periprosthetic Joint Infection

Aggarwal

Deirmengian

Parvızı

et al. 2013

Clinical Orthopaedics &Amp; Related Research

146

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Background While it is accepted accurate identification of infecting organisms is crucial in guiding treatment of periprosthetic joint infection (PJI), there remains no consensus regarding the best method for obtaining cultures. Questions/purposes We compared the yield of intraoperative tissue samples versus swab cultures in diagnosing PJI. Methods Tissue and swab cultures (three each) were collected prospectively during a consecutive series of 156 aseptic and septic revision arthroplasties from October 2011 to April 2012. The tissues and swabs were taken from standardized regions of the joint. After excluding 39 reimplantation procedures, we included 117 cases (74 hip, 43 knee; 30 septic, 87 aseptic) for analysis. We used a modified version of the Musculoskeletal Infection Society criteria for defining PJI, requiring three of five rather than four of six criteria. Tissue and swab cultures from septic and aseptic cases were used to calculate their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying PJI. Results Tissue cultures were positive in a higher percentage of septic cases than swab cultures: 28 of 30 (93%) versus 21 of 30 (70%). Tissue cultures were positive in two of 87 aseptic cases (2%), while swab cultures were positive in 10 of 87 (12%). The sensitivity, specificity, PPV, and NPV were 93%, 98%, 93%, and 98%, respectively, for tissue cultures and 70%, 89%, 68%, and 90%, respectively, for swab cultures. Conclusions Tissue cultures demonstrated higher sensitivity, specificity, PPV, and NPV for diagnosing PJI than swab cultures. Swab cultures had more false-negative and false-positive results than tissue cultures. Because swab cultures pose a higher risk of not identifying or incorrectly identifying infecting organisms in PJI, we believe their use in obtaining intraoperative culture specimens should be discouraged.

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“…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)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(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).…”

mentioning

confidence: 99%

“…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%

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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Prosthetic Joint Infection Diagnosis Using Broad-Range PCR of Biofilms Dislodged from Knee and Hip Arthroplasty Surfaces Using Sonication

Cited by 207 publications

References 27 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

Swab Cultures Are Not As Effective As Tissue Cultures for Diagnosis of Periprosthetic Joint Infection

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

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