An automated real‐time PCR assay for synovial fluid improves the preoperative etiological diagnosis of periprosthetic joint infection and septic arthritis
An automated real‐time PCR assay for synovial fluid improves the preoperative etiological diagnosis of periprosthetic joint infection and septic arthritis
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滑液自动实时 PCR 检测可改善假体周围感染和化脓性关节炎的术前病因诊断
DOI：
10.1002/jor.24959
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发表时间：
2020
影响因子：
2.8
通讯作者：
Inaba Yutaka
中科院分区：
文献类型：
--
作者：
Yang Fan;Choe Hyonmin;Kobayashi Naomi;Tezuka Taro;Oba Masatoshi;Miyamae Yushi;Morita Akira;Abe Koki;Inaba Yutaka
滑液对疑似假体周围关节感染（PJI）或脓毒性关节炎（SA）的术前病因诊断很重要。GENECUBE是一种自动实时聚合酶链反应（PCR）试验，用于检测细菌耐甲氧西林（methicillin resistance），并与微生物培养进行比较，用于74例疑似PJI和SA感染并准备手术的患者的术前诊断。采用ICM 2018修订诊断标准诊断PJI 21例，SA 6例。微生物培养确定6个样品的耐甲氧西林葡萄球菌（MRS）为病原菌，这些样品在GENECUBE试验中均呈阳性。同样值得注意的是，GENECUBE试验在培养阴性但感染诊断的患者中检测到6例MRS感染，并在1例不确定的病例中检测到MRS感染，这表明该试验具有更高的敏感性。与微生物培养法比较，GENECUBE法的敏感性为100%，特异性为92.2%。然而，GENECUBE也在三个病例中产生了无效结果，提示滑液样本中可能存在PCR抑制剂。我们还验证了针对16S rRNA的泛菌实时PCR和其他测试的准确性。泛菌实时PCR与术前细菌培养检测同样有效，但α防御素检测的灵敏度最高，为100%。因此，全自动实时PCR技术通过减少检测时间和降低假阳性检出率，提高了PJI和SA的病原学诊断。因此，在滑液中进行α防御素筛查和细菌抗原检测是一种更有效的术前诊断PJI和SA的方法。
Synovial fluid is important for the preoperative etiological diagnosis of suspected periprosthetic joint infection (PJI) or septic arthritis (SA). GENECUBE, an automated real‐time polymerase chain reaction (PCR) assay, was used to detect bacterialmecA(methicillin resistance) and was compared with microbiological cultures for preoperatively diagnosing PJI and SA in 74 patients suspected of these infections and thus earmarked for surgery. PJI and SA were diagnosed in 21 and 6 cases, respectively, using modified ICM 2018 diagnostic criteria. Microbiological cultures determined methicillin‐resistantstaphylococcus(MRS) as the causative organism in six samples, which were all positive in the GENECUBE assay. Significantly also, the GENECUBE assay detected six MRS infections in culture‐negative but infection‐diagnosed patients, and in one inconclusive case, suggesting a higher sensitivity of this assay. Compared with microbiological culture, the sensitivity and specificity of the GENECUBE assay formecAwas 100% and 92.2%, respectively. However, GENECUBE also produced invalid results in three cases, suggesting possible PCR inhibitors in the synovial fluid samples. We additionally validated the accuracy of pan‐bacterial real‐time PCR targeting 16S rRNA and other tests. Pan‐bacterial real‐time PCR was as effective as preoperative bacterial culture testing, although the α‐defensin assay had the highest sensitivity at 100%. Hence, fully automated real‐time PCR targeting of the bacterialmecAgene improves the etiological diagnosis of PJI and SA by reducing the testing time and lowering the false‐positive detection rates. A screening approach for α‐defensin followed by bacterialmecAgene testing in synovial fluids is therefore a more efficient method of preoperatively diagnosing PJI and SA.
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影响因子：
3.7
作者：
Miyamae Y;Inaba Y;Kobayashi N;Choe H;Yukizawa Y;Ike H;Saito T
通讯作者：
Saito T
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
影响因子：
1.7
作者：
H. Choe;Y. Inaba;N. Kobayashi;Chie Aoki;J. Machida;N. Nakamura;S. Okuzumi;Tomoyuki Saito
通讯作者：
Tomoyuki Saito
影响因子：
27.4
作者：
Weston, VC;Jones, AC;Doherty, M
通讯作者：
Doherty, M
影响因子：
1.5
作者：
Kim, Young-Hoo;Kulkarni, Sourabh S.;Rastogi, Devarshi
通讯作者：
Rastogi, Devarshi
评估实时聚合酶链式反应检测死细菌的时间段。
影响因子：
2.1
作者：
H. Choe;Y. Inaba;N. Kobayashi;Y. Miyamae;H. Ike;H. Fujimaki;T. Tezuka;Y. Hirata;Tomoyuki Saito
通讯作者：
Tomoyuki Saito