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PCR rapidly detects methicillin-resistant staphylococci periprosthetic infection
Ivan S Tarkin1, Travis J Henry, Paul I Fey
1University of Nebraska Medical Center, Veteran's Administration Medical Center, Department of Orthopaedics, Omaha, NE 68198-1080, USA. ivantarkin@cs.com
Abstract:
Optimal treatment of methicillin-resistant staphylococcal periprosthetic infections is predicated on rapid and reliable detection of these organisms. Culture has served as the gold standard for identification of these organisms despite shortcomings with sensitivity and processing time. The objective of the current study was to investigate a polymerase chain reaction assay aimed at rapid genomic detection of methicillin-resistance in staphylococci (mecA gene). The feasibility of the molecular approach first was validated using a septic arthritis model consisting of 73 synovial fluid samples inoculated with methicillin-resistant staphylococci and four negative controls. MecA polymerase chain reaction then was done on 35 clinical samples from 18 patients obtained at the time of revision arthroplasty. Results of the polymerase chain reaction were compared with culture. MecA polymerase chain reaction successfully predicted the presence of methicillin-resistant staphylococci in the septic arthritis model. In the clinical samples studied, the polymerase chain reaction results were concordant with culture results in 34 of the 35 samples tested. The one discordant result represented a false-positive culture result. The molecular assay was processed in less than 5 hours compared with 2 to 3 days for culture. Detection of methicillin-resistant staphylococci involved in periprosthetic infections by the polymerase chain reaction is a rapid and reliable approach.
Insights
Rapid polymerase chain reaction (PCR) accurately detects methicillin-resistant staphylococci in periprosthetic infections. This molecular assay is significantly faster than traditional culture methods, improving diagnostic speed.
Area of Science:
- Molecular biology
- Infectious diseases
- Orthopedic surgery
Background:
- Periprosthetic joint infections (PJIs) caused by methicillin-resistant staphylococci (MRS) require prompt diagnosis for effective treatment.
- Traditional culture methods for identifying MRS are time-consuming and can lack sensitivity.
- Rapid and reliable diagnostic tools are crucial for optimizing PJI management.
Purpose of the Study:
- To evaluate a polymerase chain reaction (PCR) assay for the rapid genomic detection of the mecA gene, indicating methicillin-resistance in staphylococci.
- To compare the performance of the mecA PCR assay against conventional culture methods in clinical samples from patients with suspected PJIs.
Main Methods:
- Validation of the mecA PCR assay using a septic arthritis model with 73 inoculated synovial fluid samples and four negative controls.
- Application of the mecA PCR assay to 35 clinical samples from 18 patients undergoing revision arthroplasty.
- Comparison of PCR results with standard culture results for methicillin-resistant staphylococci detection.
Main Results:
- The mecA PCR assay successfully identified methicillin-resistant staphylococci in the septic arthritis model.
- In clinical samples, the PCR assay showed high concordance with culture results (34 out of 35 samples).
- The PCR assay provided results in under 5 hours, significantly faster than the 2–3 days required for culture.
Conclusions:
- The mecA PCR assay is a rapid and reliable method for detecting methicillin-resistant staphylococci in periprosthetic infections.
- This molecular approach offers a significant advantage in diagnostic turnaround time compared to traditional culture.
- The findings support the use of PCR as a valuable tool for the timely diagnosis and management of MRS-related PJIs.