Infectious Diseases Service, Department of Internal Medicine, Cantonal Hospital Zug, Baar, Switzerland.
J Clin Microbiol. 2010 Apr;48(4):1208-14. doi: 10.1128/JCM.00006-10. Epub 2010 Feb 17.
The microbiological diagnosis of periprosthetic joint infection (PJI) is crucial for successful antimicrobial treatment. Cultures have limited sensitivity, especially in patients receiving antibiotics. We evaluated the value of multiplex PCR for detection of microbial DNA in sonication fluid from removed orthopedic prostheses. Cases of PJI in which the prosthesis (or part of it) was removed were prospectively included. The removed implant was sonicated, and the resulting sonication fluid was cultured and subjected to multiplex PCR. Of 37 PJI cases (17 hip prostheses, 14 knee prostheses, 4 shoulder prostheses, 1 elbow prosthesis, and 1 ankle prosthesis), pathogens were identified in periprosthetic tissue in 24 (65%) cases, in sonication fluid in 23 (62%) cases, and by multiplex PCR in 29 (78%) cases. The pathogen was detected in 5 cases in sonication fluid only (Propionibacterium acnes in all cases; none of these patients had previously received antibiotics) and in 11 cases by multiplex PCR only (all of these patients had previously received antibiotics). After exclusion of 8 cases caused by P. acnes or Corynebacterium species, which cannot be detected due to the absence of specific primers in the PCR kit, sonication cultures were positive in 17 cases and multiplex PCR sonication cultures were positive in 29 cases (59% versus 100%, respectively; P < 0.01). Among 19 cases (51%) receiving antibiotics, multiplex PCR was positive in all 19 (100%), whereas sonication cultures grew the organism in 8 (42%) (P < 0.01). Multiplex PCR of sonication fluid is a promising test for diagnosis of PJI, particularly in patients who previously received antibiotics. With modified primer sets, multiplex PCR has the potential for further improvement of the diagnosis of PJI.
在成功进行抗菌治疗方面，假体周围关节感染（PJI）的微生物学诊断至关重要。培养物的敏感性有限，尤其是在接受抗生素治疗的患者中。我们评估了从取出的骨科假体中超声液中检测微生物 DNA 的多重 PCR 的价值。前瞻性纳入了 PJI 病例，其中假体（或其部分）被取出。取出的植入物被超声处理，所得的超声液被培养并进行多重 PCR 分析。在 37 例 PJI 病例（17 例髋关节假体，14 例膝关节假体，4 例肩关节假体，1 例肘关节假体和 1 例踝关节假体）中，24 例（65%）病例的假体周围组织中鉴定出病原体，23 例（62%）病例的超声液中鉴定出病原体，29 例（78%）病例的多重 PCR 中鉴定出病原体。在 5 例仅在超声液中检测到病原体的病例中（所有病例均为痤疮丙酸杆菌；这些患者均未接受过抗生素治疗），在 11 例仅通过多重 PCR 检测到病原体的病例中（所有这些患者均接受过抗生素治疗）。排除 8 例由于 PCR 试剂盒中缺少特定引物而无法检测到的 P. acnes 或棒状杆菌属的病例后，超声培养物阳性的病例有 17 例，多重 PCR 超声培养物阳性的病例有 29 例（分别为 59%和 100%；P < 0.01）。在 19 例（51%）接受抗生素治疗的患者中，多重 PCR 均为阳性（100%），而超声培养物中生长出该菌的有 8 例（42%）（P < 0.01）。超声液的多重 PCR 是诊断 PJI 的一种很有前途的检测方法，特别是在那些先前接受过抗生素治疗的患者中。通过修改引物组，多重 PCR 有可能进一步提高 PJI 的诊断。
