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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Molecular techniques for diagnosing prosthetic joint infections
John C Hartley1, Kathryn A Harris2
1Department of Microbiology, Virology and Infection Prevention and Control, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK john.hartley@gosh.nhs.uk.
Abstract:
Prosthetic joint infections (PJI) can be broadly classed into two groups: those where there is a strong clinical suspicion of infection and those with clinical uncertainty, including 'aseptic loosening'. Confirmation of infection and identification of the causative organism along with provision of antibiotic susceptibility data are important stages in the management of PJI. Conventional microbiological culture and susceptibility testing is usually sufficient to provide this. However, it may fail due to prior antimicrobial treatment or the presence of unusual and fastidious organisms. Molecular techniques, in particular specific real-time and broad-range PCR, are available for diagnostic use in suspected PJI. In this review, we describe the techniques available, their current strengths, limitations and future development. Real-time pathogen-specific and broad-range PCR (with single sequence determination) are suitable for use as part of the routine diagnostic algorithm for clinically suspected PJI. Further development of broad-range PCR with high-throughput (next-generation) sequencing is necessary to understand the microbiome of the prosthetic joint further before this technique can be used for routine diagnostics in clinically unsuspected PJI, including aseptic loosening.
Insights
Diagnosing prosthetic joint infections (PJI) can be challenging. Molecular techniques like PCR offer improved accuracy for detecting pathogens in suspected PJI cases, aiding effective treatment strategies.
Area of Science:
- Microbiology
- Molecular Diagnostics
- Orthopedic Surgery
Background:
- Prosthetic joint infections (PJI) pose significant challenges in orthopedic surgery.
- Accurate diagnosis is crucial for effective patient management and treatment.
- Conventional methods may fail due to prior antibiotic use or fastidious organisms.
Purpose of the Study:
- To review current and emerging molecular diagnostic techniques for PJI.
- To evaluate the strengths and limitations of these methods.
- To guide the integration of molecular diagnostics into PJI management algorithms.
Main Methods:
- Review of existing literature on molecular diagnostic techniques for PJI.
- Focus on real-time PCR and broad-range PCR.
- Discussion of next-generation sequencing applications.
Main Results:
- Real-time pathogen-specific and broad-range PCR are suitable for routine diagnostics in clinically suspected PJI.
- These molecular methods enhance pathogen identification and antibiotic susceptibility.
- Next-generation sequencing requires further development for routine use in unsuspected PJI.
Conclusions:
- Molecular techniques, particularly PCR, are valuable tools for diagnosing PJI.
- Current PCR methods can be integrated into routine diagnostic workflows.
- Advanced sequencing technologies hold future promise for comprehensive PJI microbiome analysis.
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