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

Coiffier, Guillaume; David, Claire; Gauthier, Pierre-Yves; Bars, Hervé Le; Guggenbuhl, Pascal; Jolivet‐Gougeon, Anne; Albert, Jean-David

doi:10.1007/s10067-019-04492-7

Cited by 17 publications

(9 citation statements)

References 27 publications

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“…In disagreement with conventional bacterial culture results, the 16S rDNA sequencing alignment results indicated Clostridium perfringens . Given this molecular finding, the failure to detect Escherichia coli by the second culture most likely reflects the destruction of the organism in response to antibiotic therapy prior to sample collection, although the sensitivity of 16S rDNA sequencing might be superior to that of culture in cases with antibiotic exposure [ 18 , 19 ]. Meanwhile, the negative culture results of Clostridium perfringens may reflect the selective lysis of the pathogen resulting from exposure of the sample to air during sample processing, although patient specimens that arrived at the laboratory were appropriately transported for anaerobic organisms, or the strain failed to grow outside dedicated anaerobic enrichment medium [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess diagnosed by 16S rDNA sequencing: a case report

Sun

Bai

et al. 2021

Gut Pathog

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Background Gas-producing perianal abscess raises the possibility of clostridial infection, with Clostridium perfringens being the most common causative agent, which is highly lethal if untreated timely. As the treatment of clostridial infections often differs from that of non-clostridial infections, which they may closely resemble, the importance of accurate pathogenic organism identification cannot be overemphasized. The 16S rDNA of bacteria is highly conserved within a species and among species of the same genus but demonstrates substantial variation between different species, thus making it a suitable genomic candidate for bacterial detection and identification. Case presentation Here, we report the case of a 53-year-old patient who was admitted to the hospital for a gas-producing perianal abscess. The patient was managed with ceftizoxime and ornidazole and then received debridement and drainage at the lesion on the second day after admission. The bacterial cultures of the patient isolates from the debridement showed a coinfection of Escherichia coli and Enterococcus faecium. Although perianal redness and swelling subsided obviously after the surgery, the patient was febrile to 38.3℃ with his left upper thigh red and swollen, aggravated with tenderness and crepitus. Considering insufficient debridement and the risk of incorrect identification of pathogens, a second debridement and drainage were performed 4 days after the primary operation, and 16S rDNA sequencing of the isolates implicated Clostridium perfringens infection. Given the discrepancies in diagnostic results and the treatment outcomes, Enterococcus faecium was identified as sample contamination, and a diagnosis of coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess was confirmed. The patient was then successfully treated with meropenem and vancomycin and was discharged at 27 days of admission. Conclusions This case represents the first report of coinfection of both clostridial and non-clostridial organisms in gas-producing perianal abscess and the first case reporting the use of 16S rDNA sequencing in the diagnosis of perianal abscess. Timely pathogen identification is critical for treating gas-producing perianal abscess and an antibiotic regimen covering both aerobic and anaerobic organisms is recommended before true pathogens are identified.

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Section: Discussionmentioning

confidence: 99%

Coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess diagnosed by 16S rDNA sequencing: a case report

Sun

Bai

et al. 2021

Gut Pathog

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“…This was considerably lower than previously published sensitivities in veterinary medicine (73.7 to 89.5%) [ 18 , 33 , 34 ]. In humans, sensitivity ranges from 23.5 to 96.2%, and there are conflicting reports in the literature regarding whether 16S rRNA PCR improves diagnostics when diagnosing SA [ 21 , 22 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Detection of bacterial DNA in synovial fluid in dogs with arthritis: a comparison between bacterial culture and 16S rRNA polymerase chain reaction

Vilén

Nilson

Petersson³

et al. 2021

Acta Vet Scand

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Background Septic arthritis (SA) is a serious condition in dogs that requires a prompt diagnosis and treatment to minimize long-term joint pathology. Although bacterial detection in synovial fluid (SF) through culture or cytology is often performed to confirm diagnosis, the sensitivity of these tests is low. The need for a reliable diagnostic tool to confirm the presence of bacteria in SF in humans has led to the increased use of 16S rRNA (i.e., ribosomal RNA) gene sequencing by polymerase chain reaction (16S rRNA PCR). The aim of this prospective clinical study was to compare the sensitivity and specificity of 16S rRNA PCR with bacterial culture on blood agar plates after pre-incubation of SF in paediatric blood bacterial culture bottles to identify bacteria in dogs with clinical signs of SA and to investigate the usefulness of these methods as diagnostic tools. Results Ten dogs with clinical signs of SA, nine with osteoarthritis (OA, control group) and nine with clinical signs of immune-mediated polyarthritis (IMPA, second control group) were examined. Bacterial culture was positive in seven of 10 dogs with clinical SA, of which only two were positive by 16S rRNA PCR. The sensitivity of 16S rRNA PCR and bacterial culture analysis for dogs with clinical SA were 20% and 70%, respectively. All SF samples collected from control group (n = 9) and second control group (n = 14) animals were negative on culture, and 16S rRNA PCR rendered a specificity of 100%. Conclusions Our study showed a lower sensitivity of 16S rRNA PCR than bacterial culture for dogs with clinical SA. Our findings suggest that there is currently no advantage in using 16S rRNA PCR as a diagnostic tool for dogs with clinical SA. Furthermore, our study indicates that pre-incubation in paediatric blood bacterial culture bottles before bacterial cultivation on blood agar plates might enhance bacterial culture sensitivity compared to other culture methods.

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“…Literature review of the past ten years showed that the sensitivity of 16 s rDNA ranges from 20-70% from various body fluids and tissues. This wide range in sensitivity could be due to the use of different molecular testing kits and non-standardized databases [11][12][13]. In addition, false-positive results from the DNA of eradicated bacteria or free nucleic acids are a problem [13].…”

Section: Discussionmentioning

confidence: 99%

“…Culture media in the last 30 years have remained similar. The current culture technique has a sensitivity of 67-87% for the diagnosis of septic arthritis [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Polymerase chain reaction [PCR] and bacterial genome sequencing, which is increasingly used in Infectious disease diagnostic testing, especially for culture-negative samples, has not shown promising results either in the diagnosis of etiology of native joint septic arthritis [ 11 , 12 ]. Literature review of the past ten years showed that the sensitivity of 16 s rDNA ranges from 20-70% from various body fluids and tissues.…”

Section: Discussionmentioning

confidence: 99%

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Pseudoseptic Arthritis in a Patient With Psoriasis

Verdecia¹,

Ramsubeik²,

Ravi³

2021

Cureus

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A 42-year-old male with a history of untreated psoriasis and a previous episode of presumed left knee septic arthritis developed sudden onset of left knee pain, swelling, and a moderate effusion. The pathogen could not be isolated despite extensive inflammation seen in synovial fluid (SF) and synovial tissue biopsy. Whether this is culture-negative septic arthritis or pseudo-septic arthritis is the enigma, given the limited sensitivity of current available SF microbiologic testing. We present a challenging and stimulating case with no current guidelines for an optimal empiric antibiotic regimen or anti-inflammatory therapy.

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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

Cited by 17 publications

References 27 publications

Coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess diagnosed by 16S rDNA sequencing: a case report

Coinfection of Clostridium perfringens and Escherichia coli in gas-producing perianal abscess diagnosed by 16S rDNA sequencing: a case report

Detection of bacterial DNA in synovial fluid in dogs with arthritis: a comparison between bacterial culture and 16S rRNA polymerase chain reaction

Pseudoseptic Arthritis in a Patient With Psoriasis

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