Fenollar Florence, Lévy Pierre-Yves, Raoult Didier
Department of Rickettsiae, University of the Mediterranean, URMITE CNRS-IRD, Faculty of Medicine, Marseille, France.
Curr Opin Rheumatol. 2008 Jul;20(4):463-70. doi: 10.1097/BOR.0b013e3283032030.
Conventional methods such as microbiological cultures may lack the sensitivity and specificity to establish definitive diagnosis of osteoarticular infections. Herein, we review the general principles and the usefulness of broad-range PCR to improve the etiological diagnosis of osteoarticular infections.
Broad-range PCR followed by sequencing has been successfully developed to identify microorganisms involved in infections when patients have previously received antibiotics or in the presence of slow-growing or intracellular microorganisms. For osteoarticular infections, the studies have shown that the use of this molecular tool increased mainly the identification of Kingella kingae, anaerobic bacteria, and Streptococcus spp. However, it is very important to underline that the interpretation of this molecular tool is critical because of several pitfalls, including contamination causing false-positive results.
Broad-range PCR followed by sequencing offers several advantages when used to complement culture results for the diagnosis of fastidious bacteria and for patients taking antibiotics. However, its use should be restricted mainly for culture-negative cases when infection is suspected on the basis of clinical signs and symptoms or inflammatory syndrome. Future developments will include the use of real-time PCR in a closed system and pathogen-specific PCR for the molecular diagnosis of osteoarticular infections.
微生物培养等传统方法在明确骨关节炎感染的诊断时可能缺乏敏感性和特异性。在此，我们综述了广谱PCR在改善骨关节炎感染病因诊断方面的一般原则及实用性。
当患者先前已接受抗生素治疗或存在生长缓慢或细胞内微生物时，已成功开发出随后进行测序的广谱PCR来鉴定感染相关微生物。对于骨关节炎感染，研究表明使用这种分子工具主要增加了对金氏金杆菌、厌氧菌和链球菌属的鉴定。然而，必须强调的是，由于存在包括污染导致假阳性结果在内的几个陷阱，对这种分子工具的解读至关重要。
随后进行测序的广谱PCR在用于补充培养结果以诊断苛养菌及用于服用抗生素的患者时具有诸多优势。然而，其应用应主要限于根据临床体征、症状或炎症综合征怀疑感染但培养结果为阴性的病例。未来的发展将包括在封闭系统中使用实时PCR以及用于骨关节炎感染分子诊断的病原体特异性PCR。
