Usefulness of a Multiplex PCR Assay for the Diagnosis of Prosthetic Joint Infections in the Routine Setting

Abstract

Objective: To evaluate the usefulness of a multiplex polymerase chain reaction (PCR) assay as a complementary tool in the diagnosis of prosthetic joint infections in the routine setting of a clinical microbiology laboratory, with a special focus on patients at high risk of culture-negative infections and high suspicion of infection. Methods:The results obtained in the routine care setting with the use of the commercial multiplex PCR (Unyvero i60©, Curetis AG, Holzgerlingen, Germany) were retrospectively reviewed. The test was performed in samples of patients with suspected prosthetic joint infection, which were also processed for conventional diagnostic methods, including sonication of the implant when possible. Patients selected for the test were those with negative cultures after a 24-h incubation period.Results: Ninety-nine PCRs were performed, 57 of which were diagnostic of infection according to 2018 MSIS criteria.Nine patients received antibiotics within the 15 days prior to the diagnostic procedure. Tested samples included synovial fluid (33), sonication fluid (56) and tissue biopsies (10). The PCR test detected microorganisms in 26 samples: including two cases of polymicrobial infection. Eleven patients were diagnosed by using PCR only. The most frequently detected microorganism in PCR was Coagulase-Negative Staphylococcus in 11 samples, followed by Staphylococcus aureus in five. One sample was positive for the bacteria universal primer, included in the 2.0 version of the kit. Only one discrepancy was detected between a negative PCR and a positive culture. One sample was also positive for a resistance marker (detection of mecA gene in a case of methicillin-resistant S. aureus infection). Conclusion:The incorporation of the Unyvero ITI multiple PCR technique in patients selected by clinical experts is a useful tool for the diagnosis of bone and joint infections in a routine care setting. A close clinical-microbiological collaboration improves the usefulness of this kit for the management of patients with these infections.

Multiplex PCR test as an intra-operative diagnostic tool for periprosthetic joint infection in presumed aseptic revision hip and knee arthroplasty: a 1-year follow-up study of 200 cases

“…Our previous study (Jacobs et al, 2021) showed a high specificity and negative predictive value (NPV) and a low sensitivity and positive predictive value (PPV) for the mPCR Unyvero ITI G2 system. Diagnostic properties of this mPCR system were analysed by numerous other studies, reporting an excellent specificity ranging from 90 % to 100 %, indicating a positive result being truly positive with high probability (Metso et al, 2014;Hischebeth et al, 2016;Morgenstern et al, 2018;Sigmund et al, 2019Sigmund et al, , 2020Suren et al, 2020;Lüdemann et al, 2022;Auñón et al, 2022). However, the same studies reported a low sensitivity, ranging from 40 % to 80 %, meaning that a negative result does not exclude infection.…”

“…Some studies did not even report any diagnostic values (Borde et al, 2015;Malandain et al, 2018;Zannoli et al, 2021;Auñón et al, 2022) or only mentioned the sensitivity of the mPCR (Villa et al, 2017;Aamot et al, 2019). In addition, the type of sample being analysed was different amongst studies: four studies analysed sonicate fluid (Hischebeth et al, 2016;Prieto-Borja et al, 2017;Zannoli et al, 2021;Auñón et al, 2022), two studies analysed tissue alone (Borde et al, 2015;Aamot et al, 2019), two studies analysed dithiothreitol (DTT) eluate (Villa et al, 2017;Zannoli et al, 2021), and most studies analysed synovial fluid alone (Lausmann et al, 2017;Sigmund et al, 2019;Suren et al, 2020;Lausmann et al, 2020;Jacobs et al, 2021;Lüdemann et al, 2022) or in combination with other aforementioned samples (Hischebeth et al, 2016;Villa et al, 2017;Malandain et al, 2018;Auñón et al, 2022;Lafeuille et al, 2021). Furthermore, there was a difference in the type of joint aspirated in each study, whereas in almost every case the hip and knee joint were aspirated, and occasionally, the shoulder, elbow, ankle, or spine were aspirated.…”

Molecular Diagnosis of Osteoarticular Implant-Associated Infection: Available Techniques and How We Can Use Them

“…The samples selected for processing will be selected with close relationships with multidisciplinary teams, looking for patients with a probable diagnosis of PJI with a high pretest index of suspicion. We have recently published our clinical experience with this approach [71], showing that the number of patients that can benefit from a molecular test is high, even in a routine setting and not an experimental one (Figure 1). We need more reports about the experience of the laboratories in the use of molecular tests for PJI to select the best protocol to obtain the best results with the incorporation of these methods in the routine setting.…”