Detection of bacteria with molecular methods in prosthetic joint infection: sonication fluid better than periprosthetic tissue

Acta Orthop. 2016 Aug;87(4):339-45. doi: 10.3109/17453674.2016.1165558. Epub 2016 Apr 28.

Abstract

Background and purpose - The correct diagnosis of prosthetic joint infection (PJI) can be difficult because bacteria form a biofilm on the surface of the implant. The sensitivity of culture from sonication fluid is better than that from periprosthetic tissue, but no comparison studies using molecular methods on a large scale have been performed. We assessed whether periprosthetic tissue or sonication fluid should be used for molecular analysis. Patients and methods - Implant and tissue samples were retrieved from 87 patients who underwent revision operation of total knee or total hip arthroplasty. Both sample types were analyzed using broad-range (BR-) PCR targeting the 16S rRNA gene. The results were evaluated based on the definition of periprosthetic joint infection from the Workgroup of the Musculoskeletal Infection Society. Results - PJI was diagnosed in 29 patients, whereas aseptic failure was diagnosed in 58 patients. Analysis of sonication fluid using BR-PCR detected bacteria in 27 patients, whereas analysis of periprosthetic tissue by BR-PCR detected bacteria in 22 patients. In 6 of 7 patients in whom BR-PCR analysis of periprosthetic tissue was negative, low-virulence bacteria were present. The sensitivity and specificity values for periprosthetic tissue were 76% and 93%, respectively, and the sensitivity and specificity values for sonication fluid were 95% and 97%. Interpretation - Our results suggest that sonication fluid may be a more appropriate sample than periprosthetic tissue for BR-PCR analysis in patients with PJI. However, further investigation is required to improve detection of bacteria in patients with so-called aseptic failure.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Bacteria / genetics
  • Bacteria / isolation & purification*
  • Bacteriological Techniques / methods
  • DNA, Bacterial / analysis
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • Prospective Studies
  • Prosthesis-Related Infections / diagnosis*
  • Prosthesis-Related Infections / microbiology
  • Reoperation
  • Sonication / methods*

Substances

  • DNA, Bacterial