Differential contributions of specimen types, culturing, and 16S rRNA sequencing in diagnosis of prosthetic joint infections

Lone Heimann Larsen, Vesal Khalid, Yijuan Xu, Trine Rolighed Thomsen, Henrik Carl Schønheyder, The PRIS Study Group, Poul Hedevang Christensen (Medlem af forfattergruppering), Mogens Brouw Jørgensen (Medlem af forfattergruppering), Andreas Kappel (Medlem af forfattergruppering), Mogens Berg Laursen (Medlem af forfattergruppering), Poul Torben Nielsen (Medlem af forfattergruppering), Christian Pedersen (Medlem af forfattergruppering), Sten Rasmussen (Medlem af forfattergruppering), Jess Tvede Riis (Medlem af forfattergruppering), Ole Simonsen (Medlem af forfattergruppering), Ramune Aleksyniene (Medlem af forfattergruppering), Henrik Christian Bertelsen (Medlem af forfattergruppering), Rune Vincents Fisker (Medlem af forfattergruppering), Majbritt Frost (Medlem af forfattergruppering), Magdalena Kubik (Medlem af forfattergruppering)Victor Vishwanath Iyer (Medlem af forfattergruppering), Iben Ørsted (Medlem af forfattergruppering), Kåre Lehmann Nielsen (Medlem af forfattergruppering), Jeppe Lund Nielsen (Medlem af forfattergruppering), Per Halkjær Nielsen (Medlem af forfattergruppering), Kristian Kjær Petersen (Medlem af forfattergruppering), Lars Arendt-Nielsen (Medlem af forfattergruppering)

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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.
TidsskriftJournal of Clinical Microbiology
Udgave nummer5
Sider (fra-til)1-12
Antal sider12
StatusUdgivet - maj 2018