Department of Orthopaedics and Trauma, Heidelberg University Hospital, Heidelberg, Germany,
Int Orthop. 2013 Dec;37(12):2515-21. doi: 10.1007/s00264-013-2038-7. Epub 2013 Aug 6.
Prosthetic infection is the worst complication in joint arthroplasty. The diagnostic procedure is time consuming and in many cases unrewarding. The aim of this investigation was to raise the sensitivity of the diagnostic procedure.
Altogether, 229 implants were removed from 229 patients. Complete data from 157 patients could be analysed. On explantation of the respective arthroplasty, tissue was removed, puncture fluid aspirated and biofilm scratched from the implant surface with a surgical knife. Specimens were investigated with conventional culture methods and with 16S ribosomal DNA (rDNA) polymerase chain reaction (PCR) and sequencing.
In 123 cases, no pathogen could be identified by routine culture methods. In three of these culture-negative cases, bacteria could be identified with 16S rDNA sequencing of the removed biofilm. In 34 cases, bacteria could be identified with culture methods. In two of these cases, sequencing detected additional pathogens.
The process of 16S ribosomal deoxyribonucleic acid polymerase chain reaction (rDNA PCR) and sequencing of biofilm removed from the explanted prosthesis is an important addition to conventional culture methods in prosthetic joint infection. Polymerase chain reaction detects additional pathogens and improves diagnostic sensitivity. The examination of tissue, puncture fluid and biofilm should be performed in cases of prosthesis loosening and explantation.
假体感染是关节置换术最严重的并发症。诊断过程既耗时又往往没有结果。本研究旨在提高诊断过程的敏感性。
总共从 229 名患者中取出了 229 个植入物。对 157 名患者的完整数据进行了分析。在取出相应的关节假体时，从植入物表面用手术刀刮取组织、抽吸穿刺液并刮取生物膜。用常规培养方法和 16S 核糖体 DNA（rDNA）聚合酶链反应（PCR）和测序对标本进行了检测。
在 123 例中，常规培养方法无法鉴定病原体。在这 3 例培养阴性的病例中，通过去除的生物膜的 16S rDNA 测序可以鉴定出细菌。在 34 例中，可以通过培养方法鉴定出细菌。在其中 2 例中，测序检测到其他病原体。
从取出的假体上的生物膜中进行 16S 核糖体脱氧核糖核酸聚合酶链反应（rDNA PCR）和测序是假体关节感染中常规培养方法的重要补充。聚合酶链反应可检测出其他病原体，提高诊断敏感性。在假体松动和取出时，应检查组织、穿刺液和生物膜。
