Microbiology Laboratory, Reference Laboratory of Catalunya, Carrer de la Selva, 10, Edifici Inblau A. Parc de Negocis MasBlau I, El Prat de Llobregat, 08820 Barcelona, Spain.
J Infect. 2012 Dec;65(6):541-8. doi: 10.1016/j.jinf.2012.08.018. Epub 2012 Sep 4.
Cultures have limited sensitivity in the diagnosis of prosthetic joint infection (PJI), especially in low-grade infections. We assessed the value of multiplex PCR in differentiating PJI from aseptic failure (AF).
Included were patients in whom the joint prosthesis was removed and submitted for sonication. The resulting sonication fluid was cultured and investigated by multiplex PCR, and compared with periprosthetic tissue culture.
Among 86 explanted prostheses (56 knee, 25 hip, 3 elbow and 2 shoulder prostheses), AF was diagnosed in 62 cases (72%) and PJI in 24 cases (28%). PJI was more common detected by multiplex PCR (n=23, 96%) than by periprosthetic tissue (n=17, 71%, p=0.031) or sonication fluid culture (n=16, 67%, p=0.016). Among 12 patients with PJI who previously received antibiotics, periprosthetic tissue cultures were positive in 8 cases (67%), sonication fluid cultures in 6 cases (50%) and multiplex PCR in 11 cases (92%). In AF cases, periprosthetic tissue grew organisms in 11% and sonication fluid in 10%, whereas multiplex PCR detected no organisms.
Multiplex PCR of sonication fluid demonstrated high sensitivity (96%) and specificity (100%) for diagnosing PJI, providing good discriminative power towards AF, especially in patients previously receiving antibiotics.
培养物在诊断人工关节感染（PJI）方面的敏感性有限，尤其是在低度感染的情况下。我们评估了多重 PCR 在区分 PJI 与无菌性失败（AF）方面的价值。
纳入的患者为关节假体被取出并进行超声处理的患者。对得到的超声处理液进行培养和多重 PCR 检测，并与假体周围组织培养进行比较。
在 86 个被取出的假体中（56 个膝关节，25 个髋关节，3 个肘关节和 2 个肩关节假体），诊断为 AF 的有 62 例（72%），PJI 有 24 例（28%）。通过多重 PCR 检测到的 PJI （n=23，96%）比通过假体周围组织（n=17，71%，p=0.031）或超声处理液培养（n=16，67%，p=0.016）更为常见。在 12 例先前接受过抗生素治疗的 PJI 患者中，8 例（67%）的假体周围组织培养阳性，6 例（50%）的超声处理液培养阳性，11 例（92%）的多重 PCR 检测阳性。在 AF 病例中，假体周围组织有 11%的病例培养出病原体，超声处理液中有 10%，而多重 PCR 未检测到病原体。
超声处理液的多重 PCR 对诊断 PJI 具有较高的敏感性（96%）和特异性（100%），对 AF 具有较好的鉴别能力，尤其是在先前接受过抗生素治疗的患者中。
