Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the application of a new molecular testing diagnostic algorithm.

Autor: Ghirardelli S; Südtiroler Sanitätsbetrieb Brixen Italy.; Paracelsus Medical University (PMU), Institute of Biomechanics Paracelsus Medical University Salzburg Austria., Scaggiante F; Südtiroler Sanitätsbetrieb Brixen Italy., Troi C; Südtiroler Sanitätsbetrieb Brixen Italy., Valpiana P; Südtiroler Sanitätsbetrieb Brixen Italy.; Paracelsus Medical University (PMU), Institute of Biomechanics Paracelsus Medical University Salzburg Austria., Cristofolini G; Südtiroler Sanitätsbetrieb Brixen Italy., Aloisi G; Dipartimento di Medicina Clinica, Sanita' Pubblica, Scienze della Vita e dell'Ambiente Universita' degli Studi dell'Aquila L'Aquila Italy., Violante B; Ospedale Isola Tiberina, Gemelli Isola UOC Chirurgia Protesica e Traumatologica Rome Italy., Russo A; Universita' degli Studi di Enna 'Kore' Enna Italy., Schaller S; Paracelsus Medical University (PMU), Institute of Biomechanics Paracelsus Medical University Salzburg Austria., Indelli PF; Südtiroler Sanitätsbetrieb Brixen Italy.; Paracelsus Medical University (PMU), Institute of Biomechanics Paracelsus Medical University Salzburg Austria.; CESAT, Azienda Sanitaria Toscana Centro Fucecchio Italy.; Department of Orthopaedic Surgery Stanford University School of Medicine Redwood City California USA.
Jazyk: angličtina
Zdroj: Journal of experimental orthopaedics [J Exp Orthop] 2024 Jul 21; Vol. 11 (3), pp. e12097. Date of Electronic Publication: 2024 Jul 21 (Print Publication: 2024).
DOI: 10.1002/jeo2.12097
Abstrakt: Purpose: Pathogen identification is key in the treatment of septic arthritis (SA) and periprosthetic joint infections (PJI). This study evaluates the outcome of the application of a new, score-based SA and PJI diagnostic algorithm, which includes the execution of molecular testing on synovial fluid.
Methods: A score-based diagnostic algorithm, which includes serologic and synovial fluid markers determination using multiplex PCR (mPCR) and Next Generation Sequencing (NGS) molecular testing, has been applied to a consecutive series of patients with clinically suspected SA or PJI. Patients with a score ≥6 underwent synovial fluid molecular testing, together with traditional culture, to identify the pathogen and its genetically determined antibiotic resistance.
Results: One hundred and seventeen joints in 117 patients (62.5% women; average age 73 years) met the criteria for possible SA/PJI. The affected joint was the knee in 87.5% (joint replacement 66.5%; native joint 21%) and the hip in 12.5% (all replaced joints). 43/117 patients (36.7%) were ultimately diagnosed with SA/PJI. Among the various testing technologies applied, mPCR was the main determinant for pathogen identification in 63%, standard culture in 26%, and mNGS in 11%.  Staphylococcus aureus  and Enterococcus faecalis were the top two microorganisms identified by mPCR, while  Staphylococcus epidermidis  was the prevalent organism identified by NGS. mPCR detected the presence/absence of the genetically determined antibiotic resistance of all identified microorganisms. The average timeframe for pathogen identification was 3.13 h for mPCR, 4.5 days for culture, and 3.2 days for NGS.
Conclusions: Molecular diagnostic technologies represent an innovative screening for fast microorganism identification when a joint infection is clinically suspected.
Level of Evidence: Level IV, case series.
Competing Interests: The authors declare no conflict of interest.
(© 2024 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)
Databáze: MEDLINE
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