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Low sensitivity of periprosthetic tissue PCR for prosthetic knee infection diagnosis
Seong Yeol Ryu1, Kerryl E Greenwood-Quaintance1, Arlen D Hanssen2
1Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
Abstract:
We previously described a rapid PCR panel targeting bacteria associated with prosthetic joint infection (PJI) for use on biofilms dislodged from explanted hip and knee arthroplasties. Herein, we tested the PCR panel on periprosthetic tissues from 95 subjects undergoing resection knee arthroplasty, all of whom had had tissue cultures performed. A subset also had synovial fluid culture (n=89) and/or device vortexing and sonication with culture (n=58), and a subset of these PCR (n=36) of resulting sonicate fluid, performed. Of the 64 subjects with PJI, 10 and 44 had positive tissue PCR and cultures, respectively, one of whom had a positive tissue PCR with negative tissue cultures. The overall sensitivity of tissue PCR (16%) was much lower than that of tissue (69%), synovial fluid (72%) and sonicate fluid (77%) culture as well as sonicate fluid PCR (78%) (P < 0.00001, P < 0.00001, P < 0.00001, and P=0.0003, respectively). Periprosthetic tissue PCR, as performed herein, has poor sensitivity for PJI diagnosis.
Insights
A rapid PCR test for prosthetic joint infection (PJI) showed low sensitivity when used on periprosthetic tissues. Tissue PCR is not a reliable diagnostic tool for PJI compared to traditional cultures.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Molecular Diagnostics
Background:
- Prosthetic joint infection (PJI) is a serious complication of arthroplasty.
- Accurate and rapid diagnosis of PJI is crucial for effective treatment.
- Previous work developed a PCR panel for bacteria in PJI biofilms.
Purpose of the Study:
- To evaluate the diagnostic performance of a rapid PCR panel targeting PJI bacteria in periprosthetic tissues.
- To compare the sensitivity of periprosthetic tissue PCR with conventional culture methods.
Main Methods:
- A rapid PCR panel was tested on periprosthetic tissue samples from 95 patients undergoing knee arthroplasty.
- Conventional tissue, synovial fluid, and sonicate fluid cultures were performed.
- PCR was also performed on sonicate fluid from a subset of explanted devices.
Main Results:
- The sensitivity of periprosthetic tissue PCR for PJI diagnosis was 16%.
- Tissue PCR sensitivity was significantly lower than tissue culture (69%), synovial fluid culture (72%), sonicate fluid culture (77%), and sonicate fluid PCR (78%).
- One case showed positive tissue PCR with negative tissue cultures, highlighting a discrepancy.
Conclusions:
- Periprosthetic tissue PCR, as applied in this study, demonstrates poor sensitivity for diagnosing prosthetic joint infection.
- Conventional culture methods, particularly sonicate fluid analysis, remain more sensitive for PJI detection.
- Further optimization or alternative sample types are needed for PCR-based PJI diagnostics.
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