TY - JOUR
T1 - Differential contributions of specimen types, culturing, and 16S rRNA sequencing in diagnosis of prosthetic joint infections
AU - Larsen, Lone Heimann
AU - Khalid, Vesal
AU - Xu, Yijuan
AU - Thomsen, Trine Rolighed
AU - Schønheyder, Henrik Carl
AU - The PRIS Study Group
A2 - Christensen, Poul Hedevang
A2 - Jørgensen, Mogens Brouw
A2 - Kappel, Andreas
A2 - Laursen, Mogens Berg
A2 - Nielsen, Poul Torben
A2 - Pedersen, Christian
A2 - Rasmussen, Sten
A2 - Riis, Jess Tvede
A2 - Simonsen, Ole
A2 - Aleksyniene, Ramune
A2 - Bertelsen, Henrik Christian
A2 - Fisker, Rune Vincents
A2 - Frost, Majbritt
A2 - Kubik, Magdalena
A2 - Iyer, Victor Vishwanath
A2 - Ørsted, Iben
A2 - Nielsen, Kåre Lehmann
A2 - Nielsen, Jeppe Lund
A2 - Nielsen, Per Halkjær
A2 - Petersen, Kristian Kjær
A2 - Arendt-Nielsen, Lars
PY - 2018/5
Y1 - 2018/5
N2 - Prosthetic joint failure is mainly caused by infection, aseptic failure (AF), and mechanical problems. Infection detection has been improved with modified culture methods and molecular diagnostics. However, comparisons between modified and conventional microbiology methods are difficult due to variations in specimen sampling. In this prospective, multidisciplinary study of hip or knee prosthetic failures, we assessed the contributions of different specimen types, extended culture incubations, and 16S rRNA sequencing for diagnosing prosthetic joint infections (PJI). Project specimens included joint fluid (JF), bone biopsy specimens (BB), soft-tissue biopsy specimens (STB), and swabs (SW) from the prosthesis, collected in situ, and sonication fluid collected from prosthetic components (PC). Specimens were cultured for 6 (conventional) or 14 days, and 16S rRNA sequencing was performed at study completion. Of the 156 patients enrolled, 111 underwent 114 surgical revisions (cases) due to indications of either PJI (n = 43) or AF (n = 71). Conventional tissue biopsy cultures confirmed PJI in 28/43 (65%) cases and refuted AF in 3/71 (4%) cases; one case was not evaluable. Based on these results, minor diagnostic adjustments were made. Fourteen-day cultures of JF, STB, and PC specimens confirmed PJI in 39/42 (93%) cases, and 16S rRNA sequencing confirmed PJI in 33/42 (83%) cases. One PJI case was confirmed with 16S rRNA sequencing alone and five with cultures of project specimens alone. These findings indicated that JF, STB, and PC specimen cultures qualified as an optimal diagnostic set. The contribution of sequencing to diagnosis of PJI may depend on patient selection; this hypothesis requires further investigation.
AB - Prosthetic joint failure is mainly caused by infection, aseptic failure (AF), and mechanical problems. Infection detection has been improved with modified culture methods and molecular diagnostics. However, comparisons between modified and conventional microbiology methods are difficult due to variations in specimen sampling. In this prospective, multidisciplinary study of hip or knee prosthetic failures, we assessed the contributions of different specimen types, extended culture incubations, and 16S rRNA sequencing for diagnosing prosthetic joint infections (PJI). Project specimens included joint fluid (JF), bone biopsy specimens (BB), soft-tissue biopsy specimens (STB), and swabs (SW) from the prosthesis, collected in situ, and sonication fluid collected from prosthetic components (PC). Specimens were cultured for 6 (conventional) or 14 days, and 16S rRNA sequencing was performed at study completion. Of the 156 patients enrolled, 111 underwent 114 surgical revisions (cases) due to indications of either PJI (n = 43) or AF (n = 71). Conventional tissue biopsy cultures confirmed PJI in 28/43 (65%) cases and refuted AF in 3/71 (4%) cases; one case was not evaluable. Based on these results, minor diagnostic adjustments were made. Fourteen-day cultures of JF, STB, and PC specimens confirmed PJI in 39/42 (93%) cases, and 16S rRNA sequencing confirmed PJI in 33/42 (83%) cases. One PJI case was confirmed with 16S rRNA sequencing alone and five with cultures of project specimens alone. These findings indicated that JF, STB, and PC specimen cultures qualified as an optimal diagnostic set. The contribution of sequencing to diagnosis of PJI may depend on patient selection; this hypothesis requires further investigation.
KW - 16S
KW - 16S RNA
KW - Biofilm
KW - Biofilms
KW - Diagnosis (microbiology)
KW - Diagnostics
KW - Infection
KW - Joint infections
KW - Joint prosthesis
KW - Prospective clinical study
KW - Prosthesis infections
KW - RNA
KW - Ribosomal
UR - http://www.scopus.com/inward/record.url?scp=85046301622&partnerID=8YFLogxK
U2 - 10.1128/JCM.01351-17
DO - 10.1128/JCM.01351-17
M3 - Journal article
C2 - 29444832
SN - 0095-1137
VL - 56
SP - 1
EP - 12
JO - Journal of Clinical Microbiology
JF - Journal of Clinical Microbiology
IS - 5
M1 - e01351-17
ER -