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Culture Negative Pasteurella multocida Confirmed Prosthetic Hip Infection using Next-generation Sequencing
Henry Kuechly1, Rajul Gupta1, Sarah Kurkowski1
1Department of Orthopedic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Introduction:
Prosthetic joint infections (PJIs) are a dreaded complication of joint arthroplasty. Zoonotic organisms such as Pasteurella multocida (PM) rarely cause PJIs. Still, these organisms can be challenging to treat due to a low suspicion index and inadequate growth on culture. Next-generation sequencing (NGS) can be used to identify organisms in culture-negative PJIs. This is the first reported case of a PM positive total hip arthroplasty PJI using NGS.
Case Report:
We report the case of a 70-year-old male presenting with a periprosthetic hip infection. PM was identified in high relative abundance on NGS and grew in culture. Subsequent intraoperative samples were culture negative for Pasteurella, but NGS demonstrated continued presence of Pasteurella.
Conclusion:
PM is a rare case of PJI, but a high index of suspicion must be maintained in the appropriate clinical context. NGS is a vital tool for the identification of culture-negative organisms like PM.
Insights
Pasteurella multocida (PM) rarely causes prosthetic joint infections (PJIs). Next-generation sequencing (NGS) identified PM in a hip arthroplasty PJI, even when cultures were negative, highlighting NGS
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Prosthetic joint infections (PJIs) are a significant complication following joint arthroplasty.
- Zoonotic organisms, like Pasteurella multocida (PM), are uncommon causes of PJIs.
- Diagnosis of PM-associated PJIs can be challenging due to low clinical suspicion and variable culture growth.
Observation:
- A 70-year-old male presented with a periprosthetic hip infection.
- Next-generation sequencing (NGS) detected PM in high abundance.
- Intraoperative cultures were negative for PM, but NGS confirmed its continued presence.
Findings:
- This case represents the first report of a PM-positive total hip arthroplasty PJI diagnosed using NGS.
- NGS identified PM when conventional cultures were negative, indicating its utility in challenging cases.
- The persistent presence of PM detected by NGS, despite negative cultures, underscores the diagnostic power of molecular methods.
Implications:
- A high index of suspicion for rare organisms like PM is crucial in diagnosing PJIs.
- NGS is an invaluable tool for identifying causative agents in culture-negative PJIs.
- This case highlights the importance of considering zoonotic pathogens and advanced diagnostic techniques in PJI management.
