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Identification of the same species in at least two intra-operative samples for prosthetic joint infection diagnostics yields the best results with broad-range polymerase chain reaction

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Abstract

Purpose

Prosthetic joint infection (PJI) is a devastating complication of total joint arthroplasty. No single laboratory test has perfect sensitivity and specificity; however, culture of periprosthetic tissue is the standard method for PJI diagnosis. Interpretation of positive culture results in PJI diagnostics can be difficult due to the possibility of contamination with microorganisms originating from skin micro flora. Criteria have been established to aid in distinguishing pathogen from contaminant for culture results. A similar criterion has not however been established for polymerase chain reaction (PCR) analysis, which is in part responsible for confusion about the reliability of PCR for PJI diagnostics. The aim of our study was to establish a criterion for interpretation of broad range (BR) PCR results in PJI diagnostics.

Methods

Samples of periprosthetic tissue were retrieved from 100 patients with joint prosthesis failure and analysed with BR-PCR. The results of BR-PCR were evaluated based on the number of samples of periprosthetic tissue with the same bacterial species.

Results

The sensitivity (87.5 %) of BR-PCR was highest if the same species was present in at least one sample, although this criterion also resulted in the lowest specificity (92.1 %). The sensitivity decreased (83.2 %), although without a statistically significant difference, if the same species was present in two or more samples but, at the same time, specificity increased (100 %), with a statistically significant difference.

Conclusions

For diagnostics of PJI with BR-PCR the criterion of the same bacterial species in at least two specimens of periprosthetic tissue from the same patient should be used for interpretation of positive results.

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References

  1. Achermann Y, Vogt M, Leunig M, Wust J, Trampuž A (2010) Improved diagnosis of periprosthetic joint infection by multiplex PCR of sonication fluid from removed implants. J Clin Microbiol 48:1208–1214. doi:10.1128/JCM.00006-10

    Article  PubMed Central  PubMed  Google Scholar 

  2. Dempsey KE, Riggio MP, Lennon A, Hannah VE, Ramage G, Allan D, Bagg J (2007) Identification of bacteria on the surface of clinically infected and non-infected prosthetic hip joints removed during revision arthroplasties by 16S rRNA gene sequencing and by microbiological culture. Arthritis Res Ther 9:R46. doi:10.1186/ar2201

    Article  PubMed Central  PubMed  Google Scholar 

  3. 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. doi:10.1128/JCM.44.3.1018-1028.2006

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Gomez E, Cazanave C, Cunningham SA, Greenwood-Quaintance KE, Steckelberg JM, Uhl JR, Hanssen AD, Karau MJ, Schmidt SM, Osmon DR, Berbari EF, Mandrekar J, Patel R (2012) Prosthetic joint infection diagnosis using broad-range PCR of biofilms dislodged from knee and hip arthroplasty surfaces using sonication. J Clin Microbiol 50:3501–3508. doi:10.1128/JCM.00834-12

    Article  PubMed Central  PubMed  Google Scholar 

  5. Marin M, Garcia-Lechuz JM, Alonso P, Villanueva M, Alcala L, Gimeno M, Cercenado E, Sanchez-Somolinos M, Radice C, Bouza E (2012) Role of universal 16S rRNA gene PCR and sequencing in diagnosis of prosthetic joint infection. J Clin Microbiol 50:583–589. doi:10.1128/JCM.00170-11

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Panousis K, Grigoris P, Butcher I, Rana B, Reilly JH, Hamblen DL (2005) Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92 cases. Acta Orthop 76:341–346

    PubMed  Google Scholar 

  7. Bjerkan G, Witso E, Nor A, Viset T, Loseth K, Lydersen S, Persen L, Bergh K (2012) A comprehensive microbiological evaluation of fifty-four patients undergoing revision surgery due to prosthetic joint loosening. J Med Microbiol 61:572–581. doi:10.1099/jmm.0.036087-0

    Article  CAS  PubMed  Google Scholar 

  8. Atkins BL, Athanasou N, Deeks JJ, Crook DW, Simpson H, Peto TE, McLardy-Smith P, Berendt AR (1998) Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group. J Clin Microbiol 36:2932–2939

    PubMed Central  CAS  PubMed  Google Scholar 

  9. Holinka J, Krepler P, Matzner M, Grohs JG (2011) Stabilising effect of dynamic interspinous spacers in degenerative low-grade lumbar instability. Int Orthop 35:395–400. doi:10.1007/s00264-010-1017-5

    Article  PubMed Central  PubMed  Google Scholar 

  10. Kamme C, Lindberg L (1981) Aerobic and anaerobic bacteria in deep infections after total hip arthroplasty: differential diagnosis between infectious and non-infectious loosening. Clin Orthop Relat Res 154:201–207

    PubMed  Google Scholar 

  11. Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357:654–663. doi:10.1056/NEJMoa061588

    Article  CAS  PubMed  Google Scholar 

  12. Elgeidi A, Elganainy AE, Abou Elkhier N, Rakha S (2014) Interleukin-6 and other inflammatory markers in diagnosis of periprosthetic joint infection. Int Orthop. doi:10.1007/s00264-014-2475-y

    PubMed  Google Scholar 

  13. Friedrich M, Randau T, Wimmer M, Reichert B, Kuberra D, Stoffel-Wagner B, Wirtz D, Gravius S (2014) Lipopolysaccharide-binding protein: A valuable biomarker in the differentiation between periprosthetic joint infection and aseptic loosening? Int Orthop. doi:10.1007/s00264-014-2351-9

  14. Janz V, Wassilew GI, Hasart O, Matziolis G, Tohtz S, Perka C (2013) Evaluation of sonicate fluid cultures in comparison to histological analysis of the periprosthetic membrane for the detection of periprosthetic joint infection. Int Orthop 37:931–936. doi:10.1007/s00264-013-1853-1

    Article  PubMed Central  PubMed  Google Scholar 

  15. Maier GS, Horas K, Seeger JB, Roth KE, Kurth AA, Maus U (2014) Is there an association between periprosthetic joint infection and low vitamin D levels? Int Orthop 38:1499–1504. doi:10.1007/s00264-014-2338-6

    Article  PubMed  Google Scholar 

  16. Clarke MT, Roberts CP, Lee PT, Gray J, Keene GS, Rushton N (2004) Polymerase chain reaction can detect bacterial DNA in aseptically loose total hip arthroplasties. Clin Orthop Relat Res 427:132–137

    Article  PubMed  Google Scholar 

  17. De Man FH, Graber P, Luem M, Zimmerli W, Ochsner PE, Sendi P (2009) Broad-range PCR in selected episodes of prosthetic joint infection. Infection 37:292–294. doi:10.1007/s15010-008-8246-1

    Article  PubMed  Google Scholar 

  18. Vandercam B, Jeumont S, Cornu O, Yombi JC, Lecouvet F, Lefevre P, Irenge LM, Gala JL (2008) Amplification-based DNA analysis in the diagnosis of prosthetic joint infection. J Mol Diagn 10:537–543. doi:10.2353/jmoldx.2008.070137

    Article  PubMed Central  PubMed  Google Scholar 

  19. Xu Y, Rudkjobing VB, Simonsen O, Pedersen C, Lorenzen J, Schonheyder HC, Nielsen PH, Thomsen TR (2012) Bacterial diversity in suspected prosthetic joint infections: an exploratory study using 16S rRNA gene analysis. FEMS Immunol Med Microbiol 65:291–304. doi:10.1111/j.1574-695X.2012.00949.x

    Article  CAS  PubMed  Google Scholar 

  20. Rak M, Barlic-Maganja D, Kavcic M, Trebse R, Cor A (2013) Comparison of molecular and culture method in diagnosis of prosthetic joint infection. FEMS Microbiol Lett 343:42–48. doi:10.1111/1574-6968.12125

    Article  CAS  PubMed  Google Scholar 

  21. Devulder G, Perriere G, Baty F, Flandrois JP (2003) BIBI, a bioinformatics bacterial identification tool. J Clin Microbiol 41:1785–1787. doi:10.1128/jcm.41.4.1785-1787.2003

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Lowry R (2001) Clinical calculator 1. http://www.vassarstats.net/clin1.html. Accessed 30 September 2014

  23. Morawietz L, Tiddens O, Mueller M, Tohtz S, Gansukh T, Schroeder JH, Perka C, Krenn V (2009) Twenty-three neutrophil granulocytes in 10 high-power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening. Histopathology 54:847–853. doi:10.1111/j.1365-2559.2009.03313.x

    Article  PubMed  Google Scholar 

  24. Müller M, Morawietz L, Hasart O, Strube P, Perka C, Tohtz S (2008) Diagnosis of periprosthetic infection following total hip arthroplasty—evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection. J Orthop Surg Res 3:1–8. doi:10.1186/1749-799x-3-31

    Article  Google Scholar 

  25. Portillo ME, Salvado M, Sorli L, Alier A, Martinez S, Trampuz A, Gomez J, Puig L, Horcajada JP (2012) Multiplex PCR of sonication fluid accurately differentiates between prosthetic joint infection and aseptic failure. J Infect 65:541–548. doi:10.1016/j.jinf.2012.08.018

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the Slovenian Research Agency (program grant no J3-2218).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Faculty of Health Sciences, University of Primorska, Polje 42, 6310, Izola, Slovenia

    Mitja Rak, Darja Barlič-Maganja & Andrej Cőr

  2. Medical Microbiology Department, Institute of Public Health Koper, Verdijeva ulica 11, 6000, Koper, Slovenia

    Martina Kavčič

  3. Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280, Ankaran, Slovenia

    Rihard Trebše & Andrej Cőr

Authors
  1. Mitja Rak
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  2. Darja Barlič-Maganja
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  3. Martina Kavčič
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  4. Rihard Trebše
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  5. Andrej Cőr
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Correspondence to Mitja Rak.

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Rak, M., Barlič-Maganja, D., Kavčič, M. et al. Identification of the same species in at least two intra-operative samples for prosthetic joint infection diagnostics yields the best results with broad-range polymerase chain reaction. International Orthopaedics (SICOT) 39, 975–979 (2015). https://doi.org/10.1007/s00264-014-2552-2

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  • DOI: https://doi.org/10.1007/s00264-014-2552-2

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