Diagnosis of periprosthetic joint infection using alpha-defensin test or multiplex-PCR: ideal diagnostic test still not found

Suda, Arnold J.; Tinelli, Marco; Beisemann, Nils; Weil, Yoram A.; Khoury, Amal; Bischel, Oliver

doi:10.1007/s00264-017-3412-7

Cited by 63 publications

(39 citation statements)

References 35 publications

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“…Our results of clinical samples showed that in periprosthetic tissues PCR has poor sensitivity (15.4% for conventional PCR and 23% for viability PCR) as previously found by Ryu et al [27], Suda et al [28], and Huang et al [29]. They reported sensitivities of 16%, 30.8%, and 34% respectively.…”

Section: Discussionsupporting

confidence: 71%

Propidium monoazide–polymerase chain reaction for detection of residual periprosthetic joint infection in two-stage revision

et al. 2019

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False negative culture results in periprosthetic joint infection (PJI) are not uncommon particularly when patients have received long term antibiotics. Polymerase chain reaction (PCR) has a lower specificity partly due to detection of residual DNA from dead bacteria. Propidium monoazide (PMA) prevents DNA from dead bacteria from being amplified during the PCR. This study aimed to determine the role of PMA in PCR for diagnosis of PJI. Clinical samples were tested by PCR with and without prior treatment with PMA and compared to conventional microbiological culture. The PCR assay included genus-specific primers for staphylococci and enterococci and species-specific primers for Cutibacterium acnes. The validated conditions of PMA treatment used in this study were 20 μM concentration and 5 and 10 min of dark incubation and photo-activation respectively. 202 periprosthetic tissues and explanted prostheses from 60 episodes in 58 patients undergoing revision arthroplasties for either PJI or non-infective causes were tested, by culture, PCR, and PMA-PCR. 14 of the 60 episodes satisfied the Musculoskeletal Infection Society (MSIS) criteria for PJI and 46 did not. Sensitivity of culture, PCR, and PMA-PCR were 50%, 71%, and 79% respectively. Specificities were 98%, 72%, and 89% respectively. All figures were calculated for episodes rather than samples. PMA-PCR enhanced both the specificity and the sensitivity of PCR. It has the potential to detect residual bacterial viability prior to reimplantation in the two-stage revision for PJI.

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Section: Discussionsupporting

confidence: 71%

Propidium monoazide–polymerase chain reaction for detection of residual periprosthetic joint infection in two-stage revision

et al. 2019

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“…Predominantly in low-grade infections, the sensitivity of this biomarker and synovial polymerase chain reaction (PCR), but their diagnostic performance has been found to be inferior to conventional diagnostic methods, with several authors recommending their use as a confirmatory tool in equivocal cases rather than as a screening tool [35,36]. Molecular tests such as synovial PCR did not outperform conventional culture in general, except in infections caused by low-virulent pathogens [37,38]. The clinical value of next generation sequencing (NGS) in the diagnosis of culturenegative PJI is currently investigated.…”

Section: Incomplete Synovial Fluid Analysismentioning

confidence: 99%

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Renz

Trampuž

et al. 2019

International Orthopaedics (SICOT)

101

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Background Misconceptions and errors in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The goal of this paper is to systematically describe twenty common mistakes in the diagnosis and management of PJI, to help surgeons avoid these pitfalls. Materials and methods Common diagnostic and treatment errors are described, analyzed and interpreted. Results Diagnostic errors include the use of serum inflammatory biomarkers (such as C-reactive protein) to rule out PJI, incomplete evaluation of joint aspirate, and suboptimal microbiological procedures (such as using swabs or collection of insufficient number of periprosthetic samples). Further errors are missing possible sources of distant infection in hematogenous PJI or overreliance on suboptimal diagnostic criteria which can hinder or delay the diagnosis of PJI or mislabel infections as aseptic failure. Insufficient surgical treatment or inadequate antibiotic treatment are further reasons for treatment failure and emergence of antimicrobial resistance. Finally, wrong surgical indication, both underdebridement and overdebridement or failure to individualize treatment can jeopardize surgical results. Conclusion Multidisciplinary teamwork with infectious disease specialists and microbiologists in collaboration with orthopedic surgeons have a synergistic effect on the management of PJI. An awareness of the possible pitfalls can improve diagnosis and treatment results.

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“…5 Arthroplasty surgeons have used PCR for the detection of periprosthetic joint infection with mixed results. [6][7][8][9] Positive predictive values were low with a large number of false-positive results in some studies, 6,7,9 but others reported the superior value of PCR for the detection of low virulent bacteria. 8,10 Let us not forget that DNA of bacterial species is also detected in patients with inflammatory knee arthritis, associated degenerative anterior cruciate ligament (ACL) tears, and osteoarthritis.…”

mentioning

confidence: 99%

Editorial Commentary: Bacterial Load and Contamination of Anterior Cruciate Ligament Grafts—Overamplified Dreadful Nuclear Assumption (DNA) or Underestimated Problem?

Hohmann¹

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Bacterial DNA is present in a large percentage in failed anterior cruciate ligament reconstructions. A potential concern is the presence of biofilm on both failed anterior cruciate ligament reconstruction grafts and suture material. Despite the high prevalence of bacterial material observed, microbial cultures are rarely positive. However, it is currently unknown whether these findings have any clinical implications.

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Diagnosis of periprosthetic joint infection using alpha-defensin test or multiplex-PCR: ideal diagnostic test still not found

Cited by 63 publications

References 35 publications

Propidium monoazide–polymerase chain reaction for detection of residual periprosthetic joint infection in two-stage revision

Propidium monoazide–polymerase chain reaction for detection of residual periprosthetic joint infection in two-stage revision

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Editorial Commentary: Bacterial Load and Contamination of Anterior Cruciate Ligament Grafts—Overamplified Dreadful Nuclear Assumption (DNA) or Underestimated Problem?

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