J Bone Jt Infect 2017; 2(4):175-183. doi:10.7150/jbji.22062

Research Paper

Are There Benefits In Early Diagnosis Of Prosthetic Joint Infection With Multiplex Polymerase Chain Reaction?

Christian Lausmann1✉, Akos Zahar1, Mustafa Citak1, Julian Brañes2, Stefan Schmidl1, Lars Frommelt1, Thorsten Gehrke1, Matthias Gebauer1

1. Helios ENDO-Klinik Hamburg, Department of Orthopedic Surgery, Hamburg, Germany;
2. Hospital San José, University of Santiago de Chile, Santiago, Chile.

Abstract

Purpose Identification of bacteria and susceptibility are fundamental in periprosthetic joint infection (PJI). Especially in the case of systemic inflammatory response syndrome (SIRS) rapid detection of pathogens is essential for proper therapy. Bacterial cultures are time consuming. The polymerase chain reaction (PCR) is a non-culture molecular method and is able to rapidly identify pathogens and their resistance genes. Multiplex PCR (mPCR) can amplify several different DNA sequences simultaneously. The aim of this study was to show the value of mPCR for early diagnosis of PJI.

Methods 60 patients undergoing total hip or knee revisions were recruited in this prospective single-centre-study. Three groups were created: 26 patients with aseptic loosening (negative control), 26 patients with chronic PJI, and 8 patients with acute PJI/SIRS. We compared the results of joint aspirates obtained intraoperatively investigated by mPCR with the microbiology results of tissue specimens.

Results The overall sensitivity of mPCR was 78.8% (95% CI, 61.1 - 91.0%), the specificity was 100% (95% CI, 87.2 - 100%), the negative predictive value was 79.4% (95% CI, 62.1 - 91.3%), the positive predictive value was 100% (95% CI, 86.8 - 100%), and the overall accuracy was 88.3% (95% CI, 77.4 - 95.2%). The overall accuracy in acute infections/SIRS (87.5%) was greater than in late chronic PJI (76.9%). In PJI the mPCR was able to provide the results within 5 hours whereas the mean time for cultures was 6.4 days.

Conclusions Multiplex PCR is a reliable diagnostic tool in PJI management, especially in acute cases complicated with SIRS. Early diagnosis within several hours is possible, targeted antibiotic treatment can be started promptly.

Keywords: prosthetic joint infection, diagnosis, polymerase chain reaction, bacteria, susceptibility, revision arthroplasty.

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How to cite this article:
Lausmann C, Zahar A, Citak M, Brañes J, Schmidl S, Frommelt L, Gehrke T, Gebauer M. Are There Benefits In Early Diagnosis Of Prosthetic Joint Infection With Multiplex Polymerase Chain Reaction?. J Bone Jt Infect 2017; 2(4):175-183. doi:10.7150/jbji.22062. Available from http://www.jbji.net/v02p0175.htm