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) & 7 others Victor Vishwanath Iyer, Iben Ørsted, Kåre Lehmann Nielsen, Jeppe Lund Nielsen, Per Halkjær Nielsen, Kristian Kjær Petersen, Lars Arendt-Nielsen

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Abstract

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
Volume56
Issue number5
Pages (from-to)1-12
Number of pages12
ISSN0095-1137
DOIs
Publication statusPublished - May 2018

Keywords

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

Cite this

@article{c8c627d164c142aba5ec155e63c9cd5e,
title = "Differential contributions of specimen types, culturing, and 16S rRNA sequencing in diagnosis of prosthetic joint infections",
abstract = "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.",
keywords = "16S, 16S RNA, Biofilm, Biofilms, Diagnosis (microbiology), Diagnostics, Infection, Joint infections, Joint prosthesis, Prospective clinical study, Prosthesis infections, RNA, Ribosomal",
author = "Larsen, {Lone Heimann} and Vesal Khalid and Yijuan Xu and Thomsen, {Trine Rolighed} and Sch{\o}nheyder, {Henrik Carl} and {The PRIS Study Group} and Christensen, {Poul Hedevang} and J{\o}rgensen, {Mogens Brouw} and Andreas Kappel and Laursen, {Mogens Berg} and Nielsen, {Poul Torben} and Christian Pedersen and Sten Rasmussen and Riis, {Jess Tvede} and Ole Simonsen and Ramune Aleksyniene and Bertelsen, {Henrik Christian} and Fisker, {Rune Vincents} and Majbritt Frost and Magdalena Kubik and Iyer, {Victor Vishwanath} and Iben {\O}rsted and Nielsen, {K{\aa}re Lehmann} and Nielsen, {Jeppe Lund} and Nielsen, {Per Halkj{\ae}r} and Petersen, {Kristian Kj{\ae}r} and Lars Arendt-Nielsen",
year = "2018",
month = "5",
doi = "10.1128/JCM.01351-17",
language = "English",
volume = "56",
pages = "1--12",
journal = "Journal of Clinical Microbiology",
issn = "0095-1137",
publisher = "American Society for Microbiology",
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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

VL - 56

SP - 1

EP - 12

JO - Journal of Clinical Microbiology

JF - Journal of Clinical Microbiology

SN - 0095-1137

IS - 5

M1 - e01351-17

ER -