Abstract
Objective
To evaluate the diagnostic performance of bacterial identification by broad-range polymerase chain reaction (PCR) of ribosomal DNA (rDNA) 16 s (16S rDNA PCR) for the diagnosis of septic arthritis on native joints.
Methods
Patients with acute mono or oligoarthritis who underwent synovial fluid puncture and prospective follow-up allowing definitive diagnosis (septic arthritis, crystal related disease, chronic inflammatory arthritis, undifferentiated arthritis) were recruited in this single-center study. Systematic analysis of synovial fluid included leukocytes count, search for urate and pyrophosphate crystals with polarized light microscopy, direct bacteriological examination (gram staining), bacteriological culture, and 16S rDNA PCR.
Results
Ninety-five patients were included, 34 of which (35.8%) had septic arthritis. Nineteen (20.0%) patients had received probabilistic antibiotic therapy prior to joint puncture. Gram + cocci infection accounted for 79.4% of septic arthritis, of which nearly half (47.1%) was caused by Staphylococcus aureus. Eight (23.5%) septic arthritis patients had a 16S rDNA PCR positive in the synovial fluid with an AUC of 0.618 (95% CI, 0.493–0.742), a sensitivity of 0.24 (95% CI, 0.12–0.40), and a specificity of 1.00 (95% CI 0.94–1.00). The diagnostic performance of 16S rDNA PCR was lower than that of direct examination (AUC at 0.691, CI 95%, 0.570–0.812), blood cultures (AUC at 0.727, CI 95%, 0.610–0.844), and culture (0.925, CI 95%, 0.856–0.994) for the diagnosis of septic arthritis. There was no difference in the positivity of 16S rDNA PCR according to previous exposure to antibiotics.
Conclusions
16 s rDNA PCR in the synovial fluid does not improve the diagnostic performance of septic arthritis on native adult joints, particularly for Gram-positive cocci infections.
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References
Mathews CJ, Weston VC, Jones A, Field M, Coakley G (2010) Bacterial septic arthritis in adults. Lancet 375:846–855
Kennedy N, Chambers ST, Nolan I, Gallagher K, Werno A, Browne M, Stamp LK (2015) Native joint septic arthritis: epidemiology, clinical features, and microbiological causes in a New Zealand population. J Rheumatol 42:2392–2397
Gomez-Junyent J, Murillo O, Grau I, Benavent E, Ribera A, Cabo X, Tubau F, Ariza J, Pallares R (2018) Analysis of mortality in a cohort of 650 cases of bacteremic osteoarticular infections. Semin Arthritis Rheum 48:327–333
Rutherford AI, Subesinghe S, Bharucha T, Ibrahim F, Kleymann A, Galloway JB (2016) A population study of the reported incidence of native joint septic arthritis in the United Kingdom between 1998 and 2013. Rheumatology (Oxford) 55:2176–2180
Prior-Español Á, García-Mira Y, Mínguez S, Martínez-Morillo M, Gifre L, Mateo L (2018) Coexistence of septic and crystal-induced arthritis: a diagnostic challenge. A report of 25 cases. Reumatol Clín. https://doi.org/10.1016/j.reuma.2017.12.015
Ryan MJ, Kavanagh R, Wall PG, Hazleman BL (1997) Bacterial joint infections in England and Wales: analysis of bacterial isolates over a four year period. Br J Rheumatol 36:370–373
Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M (1999) Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991. Ann Rheum Dis 58:214–219
Eberst-Ledoux J, Tournadre A, Mathieu S, Mrozek N, Soubrier M, Dubost JJ (2012) Septic arthritis with negative bacteriological findings in adult native joints: a retrospective study of 74 cases. Joint Bone Spine 79:156–159
Dubost JJ (2006) Septic arthritis with no organism: a dilemma. Joint Bone Spine 73:341–343
Podglajen I, Bellery F, Poyart C, Coudol P, Buu-Hoï A, Bruneval P, Mainardi JL (2003) Comparative molecular and microbiologic diagnosis of bacterial endocarditis. Emerg Infect Dis 9:1543–1547
Goldenberger D, Künzli A, Vogt P, Zbinden R, Altwegg M (1997) Molecular diagnosis of bacterial endocarditis by broad-range PCR amplification and direct sequencing. J Clin Microbiol 35:2733–2739
Kotilainen P, Jalava J, Meurman O, Lehtonen OP, Rintala E, Seppälä OP, Eerola E, Nikkari S (1998) Diagnosis of meningococcal meningitis by broad-range bacterial PCR with cerebrospinal fluid. J Clin Microbiol 36:2205–2209
Ley BE, Linton CJ, Bennett DM, Jalal H, Foot AB, Millar MR (1998) Detection of bacteraemia in patients with fever and neutropenia using 16S rRNA gene amplification by polymerase chain reaction. Eur J Clin Microbiol Infect Dis 17:247–253
Jalava J, Skurnik M, Toivanen A, Toivanen P, Eerola E (2001) Bacterial PCR in the diagnosis of joint infection. Ann Rheum Dis 60:287–289
Fenollar F, Roux V, Stein A, Drancourt M, Raoult D (2006) Analysis of 525 samples to determine the usefulness of PCR amplification and sequencing of the 16S rRNA gene for diagnosis of bone and joint infections. J Clin Microbiol 44:1018–1028
Fihman V, Hannouche D, Bousson V, Bardin T, Lioté F, Raskine L et al (2007) Improved diagnosis specificity in bone and joint infections using molecular techniques. J Inf Secur 55:510–517
Bonilla H, Kepley R, Pawlak J, Belian B, Raynor A, Saravolatz LD et al (2011) Rapid diagnosis of septic arthritis using 16S rDNA PCR: a comparison of 3 methods. Diagn Microbiol Infect Dis 69:390–395
Morgenstern C, Renz N, Cabric S, Perka C, Trampuz A (2018) Multiplex polymerase chain reaction and microcalorimetry in synovial fluid: can pathogen-based detection assays improve the diagnosis of septic arthritis? J Rheumatol 45:1588–1593
Searns JB, Robinson CC, Wei Q, Yuan J, Hamilton S, Pretty K et al (2018) Validation of a novel molecular diagnostic panel for pediatric musculoskeletal infections: integration of the Cepheid Xpert MRSA/SA SSTI and laboratory-developed real-time PCR assays for clindamycin resistance genes and Kingella kingae detection. J Microbiol Methods 156:60–67
Newman JH (1976) Review of septic arthritis throughout the antibiotic era. Ann Rheum Dis 35:198–205
Lallemand E, Coiffier G, Arvieux C, Brillet E, Guggenbuhl P, Jolivet-Gougeon A (2016) MALDI-TOF MS performance compared to direct examination, culture, and 16S rDNA PCR for the rapid diagnosis of bone and joint infections. Eur J Clin Microbiol Infect Dis 35:857–866
Rosey AL, Abachin E, Quesnes G, Cadilhac C, Pejin Z, Glorion C, Berche P, Ferroni A (2007) Development of a broad-range 16S rDNA real-time PCR for the diagnosis of septic arthritis in children. J Microbiol Methods 68:88–93
Hernández-Rupérez MB, Suárez-Arrabal MDC, Villa-García Á, Zarzoso-Fernández S, Navarro-Gómez M, Santos-Sebastián M et al (2018) Kingella kingae as the main cause of septic arthritis: importance of molecular diagnosis. Pediatr Infect Dis J 37:1211–1216
Fenollar F, Lévy PY, Raoult D (2008) Usefulness of broad-range PCR for the diagnosis of osteoarticular infections. Curr Opin Rheumatol 20:463–470
Harris KA, Hartley JC (2003) Development of broad-range 16S rDNA PCR for use in the routine diagnostic clinical microbiology service. J Med Microbiol 52:685–691
Rantakokko-Jalava K, Jalava J (2002) Optimal DNA isolation method for detection of bacteria in clinical specimens by broad-range PCR. J Clin Microbiol 40:4211–4217
Rantakokko-Jalava K, Nikkari S, Jalava J, Eerola E, Skurnik M, Meurman O, Ruuskanen O, Alanen A, Kotilainen E, Toivanen P, Kotilainen P (2000) Direct amplification of rRNA genes in diagnosis of bacterial infections. J Clin Microbiol 38:32–39
Marrie TJ, Costerton JW (1985) Mode of growth of bacterial pathogens in chronic polymicrobial human osteomyelitis. J Clin Microbiol 22:924–933
Malandain D, Bémer P, Leroy AG, Léger J, Plouzeau C, Valentin AS, Jolivet-Gougeon A, Tandé D, Héry-Arnaud G, Lemarié C, Kempf M, Bret L, Burucoa C, Corvec S, Cottin J, Ducellier F, Abgueguen P, Balan V, Stindel E, Ansart S, Greves A, Aubin G, Touchais S, Gouin F, Boutoille D, Asseray N, Happi L, Guinard J, Razanabola F, Mille C, Cognée AS, Gayet LE, le Moal G, Thomas C, Polard JL, Arvieux C, Meheut A, Bernard L, Rosset P, Gras G, Druon J, Fèvre K (2018) Assessment of the automated multiplex-PCR Unyvero i60 ITI® cartridge system to diagnose prosthetic joint infection: a multicentre study. Clin Microbiol Infect 24:83.e1–83.e6
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Coiffier, G., David, C., Gauthier, P. et al. Broad-range 16 s rDNA PCR in synovial fluid does not improve the diagnostic performance of septic arthritis in native joints in adults: cross-sectional single-center study in 95 patients. Clin Rheumatol 38, 1985–1992 (2019). https://doi.org/10.1007/s10067-019-04492-7
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DOI: https://doi.org/10.1007/s10067-019-04492-7