Identification of silent prosthetic joint infection: preliminary report of a prospective controlled study
Identification of silent prosthetic joint infection: preliminary report of a prospective controlled study
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DOI：
10.1007/s00264-013-1955-9
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发表时间：
2013-10-01
影响因子：
2.7
通讯作者：
Martirosian, Gayane
中科院分区：
文献类型：
--
作者：
Bereza, Przemysaw L.;Ekiel, Alicja;Martirosian, Gayane
我们将检验聚合酶链反应（PCR）支持的超声可以提高非感染假体关节松动的细菌鉴定的假设。目的是利用超声和16S rRNA基因测序检测非感染假体关节松动的细菌种类。共16例患者（11名女性，5名男性），年龄46-80岁（平均年龄65.7岁），诊断为膝关节或髋关节植入物松动（平均植入物生存期102.1个月）。细菌培养和DNA测序用于检测翻修关节置换术中取出的失败植入物表面的细菌。比较术前、术中培养及DNA测序结果。同时进行组织病理学分析。阳性培养的数量随着c反应蛋白（CRP）水平的升高而增加。在12例（75%）病例中，通过关节抽吸获得的滑液培养结果与假体部件的超声结果一致。90%的滑膜液培养阴性患者可检出细菌DNA。聚合酶链反应显示两种或两种以上的细菌，通常属于同一属：皮氏Ralstonia pickettii，假单胞菌，短杆菌，乳酸杆菌，丙酸杆菌和葡萄球菌。这些微生物存在于环境中或人体上，通常与免疫力低下有关。超声程序，随后的PCR和测序提高细菌鉴定沉默假关节感染。缺乏感染的临床症状和术前和术中培养阴性并不排除植入物上存在微生物。
We will test the hypothesis that ultrasound supported by polymerase chain reaction (PCR) could improve bacterial identification in non-infected prosthetic joint loosening. The aim was to detect bacterial species in non-infected prosthetic joint loosening using ultrasound and 16S rRNA gene sequencing.A total of 16 patients (11 women and five men) aged 46-80 years (mean age 65.7) with diagnosed knee or hip implant loosening (mean implant survival of 102.1 months) were investigated. Bacterial culture and DNA sequencing were used to detect bacteria on the surface of failed implants removed during revision arthroplasty. The results of pre- and intraoperative culture and DNA sequencing were compared. Histopathological analysis was also performed.The number of positive cultures rises with a higher level of C-reactive protein (CRP). The results of the cultures from synovial fluid obtained through joint aspiration were consistent with sonicates from components of prostheses in 12 cases (75 %). Bacterial DNA was found in 90 % of patients with negative synovial fluid culture. PCR revealed two or more bacterial species, often of the same genus: Ralstonia pickettii, Pseudomonas spp., Brevibacterium spp., Lactobacillus spp., Propionibacterium spp. and Staphylococcus spp.These are micro-organisms present in the environment or on the human body and often associated with compromised immunity.The ultrasound procedure followed by PCR and sequencing improve bacterial identification in silent prosthetic joint infection. The lack of clinical signs of infection and negative preoperative and intraoperative cultures do not exclude the presence of micro-organisms on the implants.