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Comparison of culture and broad-range polymerase chain reaction methods for diagnosing periprosthetic joint infection: analysis of joint fluid, periprosthetic tissue, and sonicated fluid

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Abstract

Purpose

This study compared the diagnostic capabilities of culture and broad-range polymerase chain reaction (PCR) using joint fluid (JF), periprosthetic tissue (PT), and sonicated fluid (SF) for the diagnosis of periprosthetic joint infection (PJI).

Methods

Sixty-seven subjects underwent knee or hip revision surgery, with 53 PJI and 14 aseptic failure (AF) cases included retrospectively. JF, PT, and SF samples were collected after a suspension of antibiotics more than two weeks, and culture and broad-range PCR were performed for all samples.

Results

The sensitivities of SF culture (83.0%), JF-PCR (83.0%), and SF-PCR (84.9%) were similar (P > 0.05), but each was significantly more sensitive than JF culture (69.8%), PT culture (71.7%), and PT-PCR (34.0%) (P < 0.05). The specificities of JF culture, PT culture, SF culture, JF-PCR, PT-PCR, and SF-PCR were similar (100, 100, 85.7, 85.7, 100, and 78.6%, respectively) (P > 0.05). PCR was unable to accurately detect six polymicrobial infections and two fungal infections.

Conclusions

SF culture, JF-PCR, and SF-PCR were more sensitive than JF culture, PT culture, and PT-PCR for diagnosing PJI among patients who have stopped taking antibiotics for two weeks or more. Compared with PCR methods, SF culture has the advantage of detecting polymicrobial or fungal infections. PT-PCR proved to be insufficiently sensitive for providing correct diagnoses.

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Funding

This study was supported by the Fujian Education and Scientific Research Projects for Young Teachers (JAT170241), Fujian Youth Talents General Training Program (2014-ZQN-JC-19), Medical Innovation Project of Fujian Province (2014-CX-23), and the Key Clinical Specialty Discipline Construction Program of Fujian.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China

    Zida Huang, Qiqiao Wu, Xinyu Fang, Wenbo Li, Chaofan Zhang, Huiyi Zeng, Qijin Wang, Jianhua Lin & Wenming Zhang

  2. Department of Orthopedic Surgery, The Third Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China

    Xinyu Fang

  3. Department of Orthopedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China

    Chaofan Zhang

Authors
  1. Zida Huang
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  2. Qiqiao Wu
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  3. Xinyu Fang
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  4. Wenbo Li
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  5. Chaofan Zhang
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  9. Wenming Zhang
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Corresponding author

Correspondence to Wenming Zhang.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was approved by the Institutional Review Board with process-number 2014-047.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

The work was performed at The First Affiliated Hospital of Fujian Medical University, China.

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Huang, Z., Wu, Q., Fang, X. et al. Comparison of culture and broad-range polymerase chain reaction methods for diagnosing periprosthetic joint infection: analysis of joint fluid, periprosthetic tissue, and sonicated fluid. International Orthopaedics (SICOT) 42, 2035–2040 (2018). https://doi.org/10.1007/s00264-018-3827-9

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  • DOI: https://doi.org/10.1007/s00264-018-3827-9

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