Abstract
Purpose
Sonication of explanted prostheses improved the microbiological diagnosis of periprosthetic joint infections (PJI). We evaluated the performance of automated multiplex polymerase chain reaction (PCR) using sonication fluid for the microbiological diagnosis of PJI.
Methods
In a prospective cohort using uniform definition criteria for PJI, explanted joint prostheses were investigated by sonication and the resulting sonication fluid was analyzed by culture and multiplex PCR. McNemar’s Chi-squared test was used to compare the performance of diagnostic tests.
Results
Among 111 patients, PJI was diagnosed in 78 (70%) and aseptic failure in 33 (30%). For the diagnosis of PJI, the sensitivity and specificity of periprosthetic tissue culture was 51 and 100%, of sonication fluid culture 58 and 100%, and of sonication fluid PCR 51 and 94%, respectively. Among 70 microorganisms, periprosthetic tissue culture grew 52 (74%), sonication fluid culture grew 50 (71%) and sonication fluid PCR detected 37 pathogens (53%). If only organisms are considered, for which primers are included in the test panel, PCR detected 37 of 58 pathogens (64%). The sonication fluid PCR missed 19 pathogens (predominantly oral streptococci and anaerobes), whereas 7 additional microorganisms were detected only by PCR (including Cutibacterium spp. and coagulase-negative staphylococci).
Conclusions
The performance of multiplex PCR using sonication fluid is comparable to culture of periprosthetic tissue or sonication fluid. The advantages of PCR are short processing time (< 5 h) and fully automated procedure. However, culture technique is still needed due to the low sensitivity and the need of comprehensive susceptibility testing. Modification of primers or inclusion of additional ones may improve the performance of PCR, especially of low-virulent organisms.
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References
Achermann Y, Vogt M, Leunig M, et al. Improved diagnosis of periprosthetic joint infection by multiplex PCR of sonication fluid from removed implants. J Clin Microbiol. 2010;48:1208–14.
Bemer P, Plouzeau C, Tande D, et al. Evaluation of 16S rRNA gene PCR sensitivity and specificity for diagnosis of prosthetic joint infection: a prospective multicenter cross-sectional study. J Clin Microbiol. 2014;52:3583–9.
Berbari EF, Marculescu C, Sia I, et al. Culture-negative prosthetic joint infection. Clin Infect Dis. 2007;45:1113–9.
Bjarnsholt T, Ciofu O, Molin S, et al. Applying insights from biofilm biology to drug development—can a new approach be developed? Nat Rev Drug Discov. 2013;12:791–808.
Borde JP, Hacker GA, Guschl S, et al. Diagnosis of prosthetic joint infections using UMD-Universal Kit and the automated multiplex-PCR Unyvero i60 ITI cartridge system: a pilot study. Infection. 2015;43:551–60.
Cazanave C, Greenwood-Quaintance KE, Hanssen AD, et al. Rapid molecular microbiologic diagnosis of prosthetic joint infection. J Clin Microbiol. 2013;51:2280–7.
Corvec S, Portillo ME, Pasticci BM, et al. Epidemiology and new developments in the diagnosis of prosthetic joint infection. Int J Artif Organs. 2012;35:923–34.
Del Pozo JL, Patel R. Clinical practice. Infection associated with prosthetic joints. N Engl J Med. 2009;361:787–94.
Esteban J, Alonso-Rodriguez N, Del-Prado G, et al. PCR-hybridization after sonication improves diagnosis of implant-related infection. Acta Orthop. 2012;83:299–304.
Gomez E, Cazanave C, Cunningham SA, et al. Prosthetic joint infection diagnosis using broad-range PCR of biofilms dislodged from knee and hip arthroplasty surfaces using sonication. J Clin Microbiol. 2012;50:3501–8.
Hischebeth GT, Randau TM, Buhr JK, et al. Unyvero i60 implant and tissue infection (ITI) multiplex PCR system in diagnosing periprosthetic joint infection. J Microbiol Methods. 2016;121:27–32.
Jost GF, Wasner M, Taub E, et al. Sonication of catheter tips for improved detection of microorganisms on external ventricular drains and ventriculo-peritoneal shunts. J Clin Neurosci. 2014;21:578–82.
Krenn V, Morawietz L, Perino G, et al. Revised histopathological consensus classification of joint implant related pathology. Pathol Res Pract. 2014;210:779–86.
Melendez DP, Greenwood-Quaintance KE, Berbari EF, et al. Evaluation of a genus- and group-specific rapid PCR assay panel on synovial fluid for diagnosis of prosthetic knee infection. J Clin Microbiol. 2016;54:120–6.
Ochsner P, Borens O, Bodler P, et al. Infections of the musculoskeletal system—Basic principles, prevention, diagnosis and treatment. In: Swiss orthopaedics and the Swiss Society for Infectious Diseases expert group “Infections of the musculoskeletal system”, Grandvaux, Switzerland. 2016.
Oliva A, Pavone P, D’abramo A, et al. Role of sonication in the microbiological diagnosis of implant-associated infections: beyond the orthopedic prosthesis. Adv Exp Med Biol. 2016;897:85–102.
Portillo ME, Salvado M, Alier A, et al. Advantages of sonication fluid culture for the diagnosis of prosthetic joint infection. J Infect. 2014;69:35–41.
Portillo ME, Salvado M, Sorli L, et al. Multiplex PCR of sonication fluid accurately differentiates between prosthetic joint infection and aseptic failure. J Infect. 2012;65:541–8.
Portillo ME, Salvado M, Trampuz A, et al. Improved diagnosis of orthopedic implant-associated infection by inoculation of sonication fluid into blood culture bottles. J Clin Microbiol. 2015;53:1622–7.
Prieto-Borja L, Rodriguez-Sevilla G, Aunon A, et al. Evaluation of a commercial multiplex PCR (Unyvero i60(R)) designed for the diagnosis of bone and joint infections using prosthetic-joint sonication. Enfermedades Infecciosas y Microbiologia Clinica. 2017;35:236–42.
Rieger UM, Pierer G, Luscher NJ, et al. Sonication of removed breast implants for improved detection of subclinical infection. Aesthet Plast Surg. 2009;33:404–8.
Trampuz A, Piper KE, Jacobson MJ, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357:654–63.
Trampuz A, Steinrucken J, Clauss M, et al. New methods for the diagnosis of implant-associated infections. Revue Medicale Suisse. 2010;6:731–4.
Tschudin-Sutter S, Frei R, Dangel M, et al. Validation of a treatment algorithm for orthopaedic implant-related infections with device-retention-results from a prospective observational cohort study. Clin Microbiol Infect. 2016;22(457):e451–9.
Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645–54.
Acknowledgements
This work was supported by a research grant from the PRO-IMPLANT Foundation (http://www.pro-implant-foundation.org) and by Curetis GmbH providing diagnostic PCR test kits and reagents for this study. Part of the results was presented at the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Vienna, Austria, April 22–25, 2017 and at the 36th Annual Meeting of European Bone and Joint Infection Society (EBJIS) in Nantes, France, September 7–9, 2017.
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Renz, N., Feihl, S., Cabric, S. et al. Performance of automated multiplex PCR using sonication fluid for diagnosis of periprosthetic joint infection: a prospective cohort. Infection 45, 877–884 (2017). https://doi.org/10.1007/s15010-017-1073-5
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DOI: https://doi.org/10.1007/s15010-017-1073-5