Rapid analysis of bacterial composition in prosthetic joint infection by 16S rRNA metagenomic sequencing

Abstract

ObjectivesProsthetic joint infection (PJI) is the most common cause of arthroplasty failure. However, infection is often difficult to detect by conventional bacterial cultures, for which false-negative rates are 23% to 35%. In contrast, 16S rRNA metagenomics has been shown to quantitatively detect unculturable, unsuspected, and unviable pathogens. In this study, we investigated the use of 16S rRNA metagenomics for detection of bacterial pathogens in synovial fluid (SF) from patients with hip or knee PJI.MethodsWe analyzed the bacterial composition of 22 SF samples collected from 11 patients with PJIs (first- and second-stage surgery). The V3 and V4 region of bacteria was assessed by comparing the taxonomic distribution of the 16S rDNA amplicons with microbiome sequencing analysis. We also compared the results of bacterial detection from different methods including 16S metagenomics, traditional cultures, and targeted Sanger sequencing.ResultsPolymicrobial infections were not only detected, but also characterized at different timepoints corresponding to first- and second-stage exchange arthroplasty. Similar taxonomic distributions were obtained by matching sequence data against SILVA, Greengenes, and The National Center for Biotechnology Information (NCBI). All bacteria isolated from the traditional culture could be further identified by 16S metagenomics and targeted Sanger sequencing.ConclusionThe data highlight 16S rRNA metagenomics as a suitable and promising method to detect and identify infecting bacteria, most of which may be uncultivable. Importantly, the method dramatically reduces turnaround time to two days rather than approximately one week for conventional cultures. Cite this article: M-F. Chen, C-H. Chang, C. Chiang-Ni, P-H. Hsieh, H-N. Shih, S. W. N. Ueng, Y. Chang. Rapid analysis of bacterial composition in prosthetic joint infection by 16S rRNA metagenomic sequencing. Bone Joint Res 2019;8:367–377. DOI: 10.1302/2046-3758.88.BJR-2019-0003.R2.

Synovial Fluid Interleukin-16 Contributes to Osteoclast Activation and Bone Loss through the JNK/NFATc1 Signaling Cascade in Patients with Periprosthetic Joint Infection

“…PJI was diagnosed using the Musculoskeletal Infection Society (MSIS) criteria and was analyzed using the available evidence [42]. For a detailed description of PJI diagnostic methods, please refer to our previous articles [10,43]. All patients with PJI were scheduled to receive two-stage exchange arthroplasty.…”

Is D-dimer a reliable biomarker compared to ESR and CRP in the diagnosis of periprosthetic joint infection?

“…Different techniques and biomarkers have been explored to improve diagnostic accuracy. 4 – 6 The Musculoskeletal Infection Society (MSIS) criteria integrate laboratory and clinical findings and showed high reliability in clinical practice. In 2018, Parvizi et al 7 updated the MSIS criteria by adding D-dimer as a minor criteria.…”

Covid-19

“…An alternative approach has been reported from Singapore, which describes the reversal of the air flow to create a negative pressure within the operating room. 16 However, it is not known if this is accompanied by an increase in the rate of implant infection, which is known to pose major diagnostic 17 - 20 and treatment 21 - 24 challenges. Wong et al 25 concur with the view that a high frequency (> 25 per hour) of air changes will rapidly reduce the viral load in the operating theatre, suggesting that in terms of minimizing risk to the patient of implant infection and to the staff of COVID-19 infection, this is a pragmatic way to reduce the risk of aerosol transmission.…”