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Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the
Stefano Ghirardelli1,2, Federica Scaggiante1, Christina Troi1
1Südtiroler Sanitätsbetrieb Brixen Italy.
Purpose:
Pathogen identification is key in the treatment of septic arthritis (SA) and periprosthetic joint infections (PJI). This study evaluates the outcome of the application of a new, score-based SA and PJI diagnostic algorithm, which includes the execution of molecular testing on synovial fluid.
Methods:
A score-based diagnostic algorithm, which includes serologic and synovial fluid markers determination using multiplex PCR (mPCR) and Next Generation Sequencing (NGS) molecular testing, has been applied to a consecutive series of patients with clinically suspected SA or PJI. Patients with a score ≥6 underwent synovial fluid molecular testing, together with traditional culture, to identify the pathogen and its genetically determined antibiotic resistance.
Results:
One hundred and seventeen joints in 117 patients (62.5% women; average age 73 years) met the criteria for possible SA/PJI. The affected joint was the knee in 87.5% (joint replacement 66.5%; native joint 21%) and the hip in 12.5% (all replaced joints). 43/117 patients (36.7%) were ultimately diagnosed with SA/PJI. Among the various testing technologies applied, mPCR was the main determinant for pathogen identification in 63%, standard culture in 26%, and mNGS in 11%. Staphylococcus aureus and Enterococcus faecalis were the top two microorganisms identified by mPCR, while Staphylococcus epidermidis was the prevalent organism identified by NGS. mPCR detected the presence/absence of the genetically determined antibiotic resistance of all identified microorganisms. The average timeframe for pathogen identification was 3.13 h for mPCR, 4.5 days for culture, and 3.2 days for NGS.
Conclusions:
Molecular diagnostic technologies represent an innovative screening for fast microorganism identification when a joint infection is clinically suspected.
Level Of Evidence:
Level IV, case series.
Insights
A new diagnostic algorithm incorporating molecular testing significantly improves pathogen identification for septic arthritis and periprosthetic joint infections. This rapid molecular approach offers faster results than traditional cultures for joint infections.
Area of Science:
- Orthopedics
- Infectious Diseases
- Molecular Diagnostics
Background:
- Accurate pathogen identification is crucial for treating septic arthritis (SA) and periprosthetic joint infections (PJI).
- Current diagnostic methods can be time-consuming, delaying appropriate treatment.
- Novel molecular techniques offer potential for faster and more accurate pathogen detection.
Purpose of the Study:
- To evaluate the effectiveness of a new score-based diagnostic algorithm for SA and PJI.
- To assess the utility of molecular testing, including multiplex PCR (mPCR) and Next Generation Sequencing (NGS), on synovial fluid for pathogen identification.
Main Methods:
- A score-based diagnostic algorithm was applied to patients with suspected SA or PJI.
- Patients with a score ≥6 underwent synovial fluid molecular testing (mPCR, NGS) and traditional culture.
- Genetically determined antibiotic resistance was also assessed.
Main Results:
- Of 117 patients, 43 (36.7%) were diagnosed with SA/PJI.
- mPCR was the primary method for pathogen identification (63%), followed by culture (26%) and NGS (11%).
- Average identification time: mPCR (3.13 hours), NGS (3.2 days), culture (4.5 days).
Conclusions:
- Molecular diagnostic technologies provide rapid microorganism identification for suspected joint infections.
- The score-based algorithm integrating molecular testing enhances diagnostic efficiency for SA and PJI.
- Faster pathogen identification through molecular methods can expedite treatment decisions.
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