Multiplex PCR of sonication fluid accurately differentiates between prosthetic joint infection and aseptic failure
Multiplex PCR of sonication fluid accurately differentiates between prosthetic joint infection and aseptic failure
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DOI：
10.1016/j.jinf.2012.08.018
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发表时间：
2012-12-01
影响因子：
28.2
通讯作者：
Pablo Horcajada, Juan
中科院分区：
文献类型：
--
作者：
Eugenia Portillo, Maria;Salvado, Margarita;Pablo Horcajada, Juan
目的：细菌培养在人工关节感染（PJI）诊断中的敏感性有限，尤其是在低度感染中。我们评估了多重PCR在区分PJI与无菌性衰竭（AF）中的价值。方法：纳入了关节假体取出并接受超声处理的患者。结果：86例假体（膝关节56例，髋关节25例，肘关节3例，肩关节2例）中，AF诊断62例（72%），PJI诊断24例（28%）。多重PCR（n=23，96%）比假体周围组织（n=17，71%，p=0.031）或超声处理液体培养（n=16，67%，p=0.016）更常检测到PJI。在12例既往接受过抗生素治疗的PJI患者中，假体周围组织培养阳性8例（67%），超声处理液培养阳性6例（50%），多重PCR阳性11例（92%）。在AF的情况下，假体周围组织生长的有机体在11%，超声处理液在10%，而多重PCR检测无organis.Conclusions：多重PCR超声处理液表现出较高的敏感性（96%）和特异性（100%）诊断PJI，提供了良好的区分力对AF，特别是在患者接受抗生素治疗。(C)2012年，英国传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Objective: Cultures have limited sensitivity in the diagnosis of prosthetic joint infection (PJI), especially in low-grade infections. We assessed the value of multiplex PCR in differentiating PJI from aseptic failure (AF).Methods: Included were patients in whom the joint prosthesis was removed and submitted for sonication. The resulting sonication fluid was cultured and investigated by multiplex PCR, and compared with periprosthetic tissue culture.Results: Among 86 explanted prostheses (56 knee, 25 hip, 3 elbow and 2 shoulder prostheses), AF was diagnosed in 62 cases (72%) and PJI in 24 cases (28%). PJI was more common detected by multiplex PCR (n=23, 96%) than by periprosthetic tissue (n=17, 71%, p=0.031) or sonication fluid culture (n=16, 67%, p=0.016). Among 12 patients with PJI who previously received antibiotics, periprosthetic tissue cultures were positive in 8 cases (67%), sonication fluid cultures in 6 cases (50%) and multiplex PCR in 11 cases (92%). In AF cases, periprosthetic tissue grew organisms in 11% and sonication fluid in 10%, whereas multiplex PCR detected no organisms.Conclusions: Multiplex PCR of sonication fluid demonstrated high sensitivity (96%) and specificity (100%) for diagnosing PJI, providing good discriminative power towards AF, especially in patients previously receiving antibiotics. (C) 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.