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 (Member of study group), Mogens Brouw Jørgensen (Member of study group), Andreas Kappel (Member of study group), Mogens Berg Laursen (Member of study group), Poul Torben Nielsen (Member of study group), Christian Pedersen (Member of study group), Sten Rasmussen (Member of study group), Jess Tvede Riis (Member of study group), Ole Simonsen (Member of study group), Ramune Aleksyniene (Member of study group), Henrik Christian Bertelsen (Member of study group), Rune Vincents Fisker (Member of study group), Majbritt Frost (Member of study group), Magdalena Kubik (Member of study group)Victor Vishwanath Iyer (Member of study group), Iben Ørsted (Member of study group), Kåre Lehmann Nielsen (Member of study group), Jeppe Lund Nielsen (Member of study group), Per Halkjær Nielsen (Member of study group), Kristian Kjær Petersen (Member of study group), Lars Arendt-Nielsen (Member of study group)

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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.
Original languageEnglish
Article numbere01351-17
JournalJournal of Clinical Microbiology
Issue number5
Pages (from-to)1-12
Number of pages12
Publication statusPublished - May 2018


  • 16S
  • 16S RNA
  • Biofilm
  • Biofilms
  • Diagnosis (microbiology)
  • Diagnostics
  • Infection
  • Joint infections
  • Joint prosthesis
  • Prospective clinical study
  • Prosthesis infections
  • RNA
  • Ribosomal

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