Successful Identification of Pathogens by Polymerase Chain Reaction (PCR)-Based Electron Spray Ionization Time-of-Flight Mass Spectrometry (ESI-TOF-MS) in Culture-Negative Periprosthetic Joint Infection
Successful Identification of Pathogens by Polymerase Chain Reaction (PCR)-Based Electron Spray Ionization Time-of-Flight Mass Spectrometry (ESI-TOF-MS) in Culture-Negative Periprosthetic Joint Infection
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DOI：
10.2106/jbjs.l.00210
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发表时间：
2012-12-19
影响因子：
5.3
通讯作者：
Parvizi, Javad
中科院分区：
文献类型：
--
作者：
Jacovides, Christina L.;Kreft, Rachael;Parvizi, Javad
背景：假体周围关节感染的诊断面临许多挑战，其中之一就是感染微生物的分离困难。最近，一种复杂的模式(宜必思生物科学T5000生物传感器系统)已经被引入，它在一系列聚合酶链式反应(PCR)中使用泛结构域引物来识别和鉴定基本上所有的细菌和真菌以及识别关键的抗生素耐药性基因。我们调查了IBIS在已知和疑似假体周围感染病例中识别感染微生物的作用。方法：前瞻性收集82例接受关节置换手术的患者的滑液样本，其中65例膝关节翻修，15例髋关节翻修，7例初次膝关节置换，并送往常规培养和IBIS分析。结果：在23例临床认为涉及假体周围关节感染的病例中，IBIS在18例中有17例通过常规培养分离到相同的病原体，在5例培养阴性的病例中有4例同时检测到一种或多种细菌。此外，在57例假性非感染性失败而行翻修人工关节置换术的病例中，IBIS检测出了50例(88%)的微生物。结论：IBIS技术不仅能有效地检测出细菌培养阴性的疑似假体周围关节感染病例，而且也提示许多以前被认为是纯粹无菌的翻修人工关节置换病例可能存在未被识别的亚临床感染的成分。
Background: The diagnosis of periprosthetic joint infection poses many challenges, one of which is the difficulty of isolating the infecting organism. Recently, a sophisticated modality (the Ibis Biosciences T5000 biosensor system) has been introduced that uses pan-domain primers in a series of polymerase chain reactions (PCRs) to identify and speciate essentially all bacteria and fungi as well as to identify key antibiotic resistance genes. We investigated the role of the Ibis in identifying infecting organisms in cases of known and suspected periprosthetic joint infection.Methods: Synovial fluid specimens were collected prospectively from eighty-two patients undergoing eighty-seven arthroplasty procedures (sixty-five knee revisions, fifteen hip revisions, and seven primary knee arthroplasties) and were sent for both conventional culture and Ibis analysis. The surgeon's clinical determination of the cause for revision arthroplasty was failure due to infection in twenty-three cases and noninfectious failure in fifty-seven cases.Results: In the twenty-three cases that were considered on clinical grounds to involve a periprosthetic joint infection, the Ibis detected the same pathogen isolated by conventional culture in seventeen of eighteen cases and also detected one or more organisms in four of the five culture-negative cases. In addition, the Ibis detected organisms in fifty (88%) of the fifty-seven cases in which revision arthroplasty was performed for a presumed noninfectious failure.Conclusions: The Ibis technology was not only effective at detecting organisms in cases of suspected periprosthetic joint infection in which cultures were negative, but it also suggested that many of the revision arthroplasty cases that have previously been considered to be purely aseptic may have a component of unrecognized, subclinical infection.