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Efficacy of a novel PCR- and microarray-based method in diagnosis of a prosthetic joint infection
Leena Metso1, Minna Mäki, Päivi Tissari
1Department of Orthopedics , Peijas Hospital, Helsinki University Central Hospital.
Background And Purpose:
Polymerase chain reaction (PCR) methods enable detection and species identification of many pathogens. We assessed the efficacy of a new PCR and microarray-based platform for detection of bacteria in prosthetic joint infections (PJIs).
Methods:
This prospective study involved 61 suspected PJIs in hip and knee prostheses and 20 negative controls. 142 samples were analyzed by Prove-it Bone and Joint assay. The laboratory staff conducting the Prove-it analysis were not aware of the results of microbiological culture and clinical findings. The results of the analysis were compared with diagnosis of PJIs defined according to the Musculoskeletal Infection Society (MSIS) criteria and with the results of microbiological culture.
Results:
38 of 61 suspected PJIs met the definition of PJI according to the MSIS criteria. Of the 38 patients, the PCR detected bacteria in 31 whereas bacterial culture was positive in 28 patients. 15 of the PJI patients were undergoing antimicrobial treatment as the samples for analysis were obtained. When antimicrobial treatment had lasted 4 days or more, PCR detected bacteria in 6 of the 9 patients, but positive cultures were noted in only 2 of the 9 patients. All PCR results for the controls were negative. Of the 61 suspected PJIs, there were false-positive PCR results in 6 cases.
Interpretation:
The Prove-it assay was helpful in PJI diagnostics during ongoing antimicrobial treatment. Without preceding treatment with antimicrobials, PCR and microarray-based assay did not appear to give any additional information over culture.
Insights
A new polymerase chain reaction (PCR) and microarray assay aids prosthetic joint infection (PJI) diagnosis during antimicrobial treatment. However, it offers no advantage over traditional culture when patients have not received prior antibiotics.
Area of Science:
- Medical Diagnostics
- Molecular Biology
- Infectious Diseases
Background:
- Polymerase chain reaction (PCR) is crucial for pathogen detection and species identification.
- Prosthetic joint infections (PJIs) require accurate and timely diagnosis for effective treatment.
Purpose of the Study:
- To evaluate the efficacy of a novel PCR and microarray-based platform for detecting bacteria in patients with suspected PJIs.
- To compare the diagnostic performance of the new assay against microbiological culture and established diagnostic criteria.
Main Methods:
- A prospective study analyzed 142 samples from 61 suspected PJIs and 20 controls using the Prove-it Bone and Joint assay.
- Results were compared with Musculoskeletal Infection Society (MSIS) criteria and microbiological culture findings.
- Laboratory staff were blinded to clinical and culture results during assay analysis.
Main Results:
- The PCR assay detected bacteria in 31 of 38 confirmed PJI cases, compared to 28 positive cultures.
- In patients undergoing antimicrobial treatment for 4 or more days, PCR detected bacteria in 6 of 9 cases, while culture yielded positive results in only 2.
- All control samples tested negative via PCR, with 6 false-positive PCR results observed among the suspected PJI cases.
Conclusions:
- The Prove-it PCR and microarray assay demonstrates utility in diagnosing PJIs, particularly in patients receiving concurrent antimicrobial therapy.
- The assay did not provide additional diagnostic information compared to standard culture methods in the absence of prior antimicrobial treatment.
