Polymerase chain reaction can detect bacterial DNA in aseptically loose total flip arthroplasties
Polymerase chain reaction can detect bacterial DNA in aseptically loose total flip arthroplasties
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DOI：
10.1097/01.blo.0000136839.90734.b7
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发表时间：
2004-10-01
影响因子：
4.2
通讯作者：
Rushton, N
中科院分区：
文献类型：
--
作者：
Clarke, MT;Roberts, CP;Rushton, N
识别失败的全髋关节置换术中的低度感染是一项重要但困难的任务。本研究调查了聚合酶链反应在因无菌原因失败的全髋关节置换术翻修过程中识别低度感染的能力。将来自 31 例全髋关节置换术的 113 个标本进行了无菌性松动修正，与来自 28 例初次全髋关节置换术的 105 例对照标本进行了比较。所有手术均在层流手术室进行。初次或修订标本均未出现微生物培养阳性。没有修复标本具有提示感染的组织学证据。使用每立方厘米标本 10 个生物体的检测阈值的聚合酶链反应，在 85 个修订组织标本中的 39 个（46%）中鉴定出细菌 DNA，而在 84 个原代组织标本中仅鉴定出 18 个细菌 DNA（21.4%）。在取自 28 例翻修全髋关节置换术 (10.7%) 的 3 个样本和取自 21 例初次全髋关节置换术 (9.5%) 的 2 个样本的滑液中发现了细菌 DNA。由于每个髋关节均发送了多个样本，因此 31 例翻修全髋关节置换术中最多有 16 例（52%）被认为受到感染，而 28 例初次全髋关节置换术中最多有 8 例（29%）被认为受到感染。在改良全髋关节置换术中获得的许多样本中都可以发现细菌 DNA，这些样本被认为是无菌松散的。由于在初次全髋关节置换术中鉴定出的细菌 DNA 被认为是由污染引起的，而不是存在于健康组织中，因此 19% 的总体样本污染率和 29% 的病例污染率表明，聚合酶链反应在此灵敏度水平下诊断翻修全髋关节置换术中感染的特异性较差。
Identifying low-grade infection in failed total hip arthroplasties is an important but difficult task. This study investigated the ability of the polymerase chain reaction to identify low-grade infection during revision of total hip arthroplasties that failed from aseptic causes. One hundred thirteen specimens from 31 total hip arthroplasties revised for aseptic loosening were compared with 105 control specimens from 28 primary total hip arthroplasties. All surgeries were done in laminar flow operating rooms. No primary or revision specimen had positive microbiologic cultures. No revision specimen had histologic evidence suggestive of infection. Using the polymerase chain reaction with a detection threshold of 10 organisms per cubic centimeter of specimen, bacterial DNA was identified in 39 of 85 revision tissue specimens (46%) compared with 18 of 84 primary tissue specimens (21.4%). Bacterial DNA was identified in the synovial fluid of three specimens taken from 28 revision total hip arthroplasties (10.7%) and in two specimens taken from 21 primary total hip arthroplasties (9.5%). As multiple specimens were sent for each hip, a maximum of 16 of 31 revision total hip arthroplasties (52%) and eight of 28 primary total hip arthroplasties (29%) were considered to be infected. Bacterial DNA can be found in many specimens obtained from revised total hip arthroplasties considered to be aseptically loose. Because bacterial DNA identified at primary total hip arthroplasty was assumed to be attributable to contamination rather than present in healthy tissues, the overall specimen contamination rate of 19% and case contamination rate of 29% indicate that the polymerase chain reaction has poor specificity at this sensitivity level for diagnosing infection in revision total hip arthroplasty.