A Clinico-Microbiological Study of Prosthetic Joint Infections in an Indian Tertiary Care Hospital: Role of Universal 16S rRNA Gene Polymerase Chain Reaction and Sequencing in Diagnosis

Abstract

Background: We determined the magnitude and clinico-microbiological profile of prosthetic joint infection (PJI) at a tertiary hospital. The diagnostic potential of 16S rRNA gene polymerase chain reaction (PCR) and sequencing on periprosthetic tissue samples was evaluated for the diagnosis of PJI. Materials and Methods: This ambispective cohort study consisted of patients who underwent primary or revision hip or knee arthroplasty from June 2013 to June 2017. The patients were classified as either infected or noninfected according to criteria set out by the musculoskeletal infection society (MSIS). Three to five periprosthetic tissue samples were collected from each patient for culture and 16S rRNA gene PCR sequencing. Results: Hundred and six patients were diagnosed to have PJI as per the MSIS Criteria. The cumulative incidence of PJI at our Institute at the end of 36 months was 1.1% (95% confidence interval [CI]: 0.59–2.91). Microorganisms were isolated by periprosthetic tissue culture (PTC) in 84 patients (sensitivity: 79% and specificity: 100%). Gram-negative aerobes were most frequently isolated (61%). Polymicrobial infections were present in 8.3% of cases. The most common infecting microorganism was Staphylococcus aureus (19.5%). Multidrug resistance and methicillin resistance were noted in 54% and 34% of bacterial isolates, respectively. The sensitivity and specificity of 16S rRNA PCR of periprosthetic tissue was 86% (95% CI: 74.9–89.9) and 100% (95% CI: 94.7–100), respectively. Periprosthetic tissue 16S rRNA PCR was more sensitive than PTC ( P = 0.008), although both were 100% specific ( P = 0.99). Conclusions: The incidence of PJI at our Institute compares well with other published reports. Contrary to previous reports, a predominance of Gram-negative PJI's was found. The preponderance of multidrug-resistant organisms in PJI's is worrisome. The high sensitivity and specificity of the 16S PCR assay used in our study support its use in culture-negative PJI suspected cases.

The role of BioFire Joint Infection Panel in diagnosing periprosthetic hip and knee joint infections in patients with unclear conventional microbiological results

“… 26 However, the sensitivity of the JI panel may be subjective and dependent on the country in which the JI panel technology is offered. 27 - 29 …”

Different microbial and resistance patterns in primary total knee arthroplasty infections – a report on 283 patients from Lithuania and Sweden

“…Although data were obtained from single centers, recently Villa et al reported a similar trend from 6 countries covering 3 continents [ 18 ]. Few studies reported contradictory findings with approximately two-thirds of Gram-negative PJIs (GN-PJIs) [ 4 , 19 ]. All these studies were conducted at single speciality centers and the majority of the cases were referred cases from other hospitals.…”

“…There are several studies on microbial profiles of infected primary TKAs but the majority are limited by a small sample size, being single-center studies, microbial profile description based on type of PJI or type of surgical management [ 3 , 4 ]. Though the previous three studies using Swedish Knee Arthroplasty Register (SKAR) data have shown the predominance of Gram-positive bacteria in knee PJIs, there are no recent reports on the microbial profile of primary TKA infections from Sweden [ 5 – 7 ].…”