Use of Real-Time Polymerase Chain Reaction for the Diagnosis of Infection and Differentiation Between Gram-Positive and Gram-Negative Septic Arthritis in Children
Use of Real-Time Polymerase Chain Reaction for the Diagnosis of Infection and Differentiation Between Gram-Positive and Gram-Negative Septic Arthritis in Children
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使用实时聚合酶链反应诊断儿童感染并区分革兰氏阳性和革兰氏阴性化脓性关节炎
DOI：
10.1097/bpo.0b013e318279c6b6
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发表时间：
2013
影响因子：
1.7
通讯作者：
Tomoyuki Saito
中科院分区：
文献类型：
--
作者：
H. Choe;Y. Inaba;N. Kobayashi;Chie Aoki;J. Machida;N. Nakamura;S. Okuzumi;Tomoyuki Saito
背景资料：儿童脓毒性关节炎（SA）的病原体的诊断和鉴定是一个重要的问题，因为基于关节感染的准确诊断的早期治疗可以预防潜在的致残并发症。本研究的目的是评价实时聚合酶链反应（PCR）诊断儿童SA的有效性。患者和方法：本研究纳入了20名患有关节疼痛并接受手术治疗的疑似SA的儿童。术前临床和实验室检查结果进行了调查。对手术中获得的组织进行微生物培养和实时PCR，包括耐甲氧西林葡萄球菌（MRS）特异性PCR和广谱通用PCR。如果微生物培养结果呈阳性，则确认感染。此外，异常的临床和实验室检查结果以及症状和治疗后数据的改善也被定义为感染的最终诊断。结果：20例患者中，19例被诊断为感染。其余患者术后诊断为幼年特发性关节炎。分别有6例、9例、15例和12例患者出现术前体温、白色细胞计数、C反应蛋白水平和红细胞沉降率异常。微生物培养阳性9例，MRS-PCR阳性2例，通用PCR阳性15例。通用PCR的熔解峰分析显示，15例中10例为革兰氏阳性，5例为革兰氏阴性。诊断SA的敏感性和特异性分别为0.47和1.00微生物培养和0.79和1.00实时PCR。结论：利用MRS-PCR和通用PCR成功地诊断了感染并区分了革兰氏阳性菌和革兰氏阴性菌。因此，实时PCR是有用的，并具有更高的灵敏度比微生物培养诊断SA的儿童。证据等级：研究诊断试验的II级诊断研究。
Background: Diagnosis and identification of the etiological agent of septic arthritis (SA) in children is an important issue, as early treatment based on accurate diagnosis of joint infections can prevent potentially disabling complications. The purpose of this study was to evaluate the efficacy of real-time polymerase chain reaction (PCR) for the diagnosis of SA in children. Patients and Methods: Twenty children with suspected SA who had joint pain and underwent surgical treatment were enrolled in this study. Their preoperative clinical and laboratory findings were investigated. Tissues obtained during operation were subjected to microbiological culture and real-time PCR, including methicillin-resistant Staphylococcus (MRS)-specific PCR and broad range universal PCR. Infection was confirmed if the result of microbiological culture was positive. Furthermore, abnormal clinical and laboratory findings and improvement in the symptoms and posttreatment data were also defined as the final diagnosis of infection. Results: Out of the 20 patients, 19 were diagnosed with the infection. The remaining patient was postoperatively diagnosed with juvenile idiopathic arthritis. Abnormal preoperative body temperatures, white blood cell counts, C-reactive protein levels, and erythrocyte sedimentation rates were observed in 6, 9, 15, and 12 cases, respectively. The results of microbiological culture, MRS-PCR, and universal PCR were positive in 9, 2, and 15 cases, respectively. Analysis of the melting peak in universal PCR revealed that of the 15 cases, 10 had gram-positive and 5 had gram-negative infections. The sensitivity and specificity for the diagnosis of SA were, respectively, 0.47 and 1.00 in microbiological culture and 0.79 and 1.00 in real-time PCR. Conclusions: Successful diagnosis of infection and differentiation between gram-positive and gram-negative bacteria were achieved using MRS-PCR and universal PCR. Hence, real-time PCR is useful and has greater sensitivity than microbial culture for diagnosing SA in children. Level of Evidence: Level II diagnostic study investigating a diagnostic test.