Clinical utilization of species-specific immunoassays for identification of Staphylococcus aureus and Streptococcus agalactiae in orthopedic infections.

Clinical utilization of species-specific immunoassays for identification of Staphylococcus aureus and Streptococcus agalactiae in orthopedic infections.
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DOI:
10.1002/jor.24935
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发表时间:
2021-10
期刊:
Journal of orthopaedic research : official publication of the Orthopaedic Research Society
影响因子:
--
通讯作者:
Oh I
Oh I
中科院分区:
其他
文献类型:
--
作者:
Sulovari A;Ninomiya MJ;Beck CA;Ricciardi BF;Ketonis C;Mesfin A;Kaplan NB;Soin SP;McDowell SM;Mahmood B;Daiss JL;Schwarz EM;Oh I

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金黄色葡萄球菌和无乳链球菌(B 族链球菌,GBS)是深部肌肉骨骼感染 (MSKI) 的常见原因,会导致严重的患者发病率和医疗保健系统成本。 MSKI 的主要挑战之一是缺乏准确的诊断来正确识别主要病原体,因为在多种微生物感染的情况下,基于标准培养的检测很容易出现假阳性,并且由于样本采集和呈现前抗生素使用的限制而出现假阴性。为了改进我们目前的 MSKI 诊断方法,我们开发了一种针对血清中抗原特异性 IgG 的多重免疫测定法 (Luminex),以及富含新合成抗体的培养基 (MENSA)。从接受手术治疗的骨科感染患者培养的外周血单核细胞 (PBMC) 中产生的金黄色葡萄球菌和 GBS。样本取自 110 名 MSKI 患者:80 名糖尿病足溃疡、21 名假体周围感染、5 名化脓性关节炎、2 名脊柱、1 名手和 1 名骨折相关感染 (FRI)。抗S。将金黄色葡萄球菌和抗 GBS 抗体滴度与培养结果进行比较,以评估它们在识别病原体方面的一致性。免疫测定,特别是 MENSA,显示出对单一微生物金黄色葡萄球菌和 GBS 骨科感染的高度诊断潜力 (AUC > 0.95)。 MENSA 还证明了对 GBS 多种微生物骨科感染和 GBS DFU 的诊断潜力(两者的 AUC > 0.83)。血清对金黄色葡萄球菌 PJI 具有较高的诊断潜力(AUC > 0.95)。总而言之,这些发现支持开发物种特异性免疫测定法,以识别活性 MSKI 中的致病病原体,特别是与标准培养相结合。
Staphylococcus aureus and Streptococcus agalactiae (Group B Streptococcus, GBS) are common causes of deep musculoskeletal infections (MSKI) and result in significant patient morbidity and cost to the healthcare system. One of the major challenges with MSKI is the lack of faithful diagnostics to correctly identify the primary pathogen, as standard culture based assays are prone to false positives in the case of polymicrobial infections, and false negatives due to limitations in sample acquisition and antibiotic use prior to presentation. To improve upon our current diagnostic methods for MSKI, we developed a multiplex immunoassay for antigen specific IgGs in serum (Luminex), and medium enriched for newly synthesized antibodies (MENSA) for anti-S. aureus and GBS generated from cultured peripheral blood mononuclear cells (PBMCs) of orthopaedic infection patients undergoing surgical treatment. Samples were obtained from 110 MSKI patients: 80 diabetic foot ulcer, 21 periprosthetic joint infection, 5 septic arthritis, 2 spine, 1 hand, and 1 fracture related infection (FRI). Anti-S. aureus and anti-GBS antibody titers were compared to culture results to assess their concordance in identifying the pathogens. Immunoassay, particularly MENSA, showed high diagnostic potential for monomicrobial S. aureus and GBS orthopaedic infections (AUC > 0.95). MENSA also demonstrated diagnostic potential for GBS polymicrobial orthopaedic infection and for GBS DFU (AUC > 0.83 for both). Serum showed high diagnostic potential for S. aureus PJI (AUC > 0.95). Taken together, these findings support the development of species-specific immunoassays for the identification of causal pathogens in active MSKI, especially in conjunction with standard culture.
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