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Multiplex PCR Unyvero i60 ITI application improves detection of low-virulent microorganisms in periprosthetic joint

Irene Katharina Sigmund1, Reinhard Windhager2, Florian Sevelda2

  • 1Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria. irene.sigmund@meduniwien.ac.at.

International Orthopaedics
|September 8, 2018
PubMed
Abstract

Insights

An automated multiplex PCR (mPCR) system shows moderate agreement with traditional cultures for diagnosing periprosthetic joint infection (PJI). This mPCR can be a useful adjunct, offering faster results and detecting more low-virulent organisms.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Molecular Diagnostics

Background:

  • Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
  • Accurate and timely diagnosis of PJI is crucial for effective treatment and patient outcomes.
  • Conventional microbiological culture methods can be slow and may fail to detect certain pathogens, particularly low-virulent ones.

Purpose of the Study:

  • To evaluate the pre-operative diagnostic performance of an automated multiplex PCR (mPCR) system for suspected PJI.
  • To compare the mPCR system's results with conventional synovial fluid cultures.
  • To assess the mPCR system's potential as an adjunct diagnostic tool for PJI.

Main Methods:

  • Synovial fluid samples were collected pre-operatively from 90 patients with suspected PJI.
  • Samples were analyzed using an automated multiplex PCR (mPCR) system.
  • Conventional microbiological culture was performed on the remaining joint fluid.
  • Diagnosis of PJI was based on the Musculoskeletal Infection Society (MSIS) criteria.
  • Agreement was measured using total percentage agreement and Cohen's kappa coefficient.

Main Results:

  • The mPCR system demonstrated 86% total agreement with synovial fluid culture (Cohen's kappa = 0.68).
  • Sensitivities were 71% for mPCR and 84% for culture; combined evaluation reached 92% sensitivity.
  • mPCR detected Cutibacterium spp. more frequently (5 vs. 1) and Coagulase-negative staphylococci (CoNS) more often (7 vs. 5) than culture.
  • mPCR missed Staphylococcus aureus in five cases compared to culture.

Conclusions:

  • The automated mPCR system shows moderate agreement with synovial fluid culture for pre-operative PJI diagnosis.
  • mPCR can serve as a valuable adjunct to conventional culture due to faster results and improved detection of certain microorganisms.
  • The system's ability to detect low-virulent organisms complements the limitations of traditional culture methods.
Keywords:
DiagnosisLow-grade infectionsLow-virulent microorganismsMultiplex PCR systemPeriprosthetic joint infection

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