Huang Zida, Wu Qiqiao, Fang Xinyu, Li Wenbo, Zhang Chaofan, Zeng Huiyi, Wang Qijin, Lin Jianhua, Zhang Wenming
Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou City, Fujian Province, China.
Department of Orthopedic Surgery, The Third Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Int Orthop. 2018 Sep;42(9):2035-2040. doi: 10.1007/s00264-018-3827-9. Epub 2018 Feb 11.
This study compared the diagnostic capabilities of culture and broad-range polymerase chain reaction (PCR) using joint fluid (JF), periprosthetic tissue (PT), and sonicated fluid (SF) for the diagnosis of periprosthetic joint infection (PJI).
Sixty-seven subjects underwent knee or hip revision surgery, with 53 PJI and 14 aseptic failure (AF) cases included retrospectively. JF, PT, and SF samples were collected after a suspension of antibiotics more than two weeks, and culture and broad-range PCR were performed for all samples.
The sensitivities of SF culture (83.0%), JF-PCR (83.0%), and SF-PCR (84.9%) were similar (P > 0.05), but each was significantly more sensitive than JF culture (69.8%), PT culture (71.7%), and PT-PCR (34.0%) (P < 0.05). The specificities of JF culture, PT culture, SF culture, JF-PCR, PT-PCR, and SF-PCR were similar (100, 100, 85.7, 85.7, 100, and 78.6%, respectively) (P > 0.05). PCR was unable to accurately detect six polymicrobial infections and two fungal infections.
SF culture, JF-PCR, and SF-PCR were more sensitive than JF culture, PT culture, and PT-PCR for diagnosing PJI among patients who have stopped taking antibiotics for two weeks or more. Compared with PCR methods, SF culture has the advantage of detecting polymicrobial or fungal infections. PT-PCR proved to be insufficiently sensitive for providing correct diagnoses.
本研究比较了使用关节液（JF）、假体周围组织（PT）和超声处理液（SF）进行培养和广谱聚合酶链反应（PCR）对假体周围关节感染（PJI）的诊断能力。
67例患者接受了膝关节或髋关节翻修手术，回顾性纳入53例PJI和14例无菌性失败（AF）病例。在停用抗生素两周以上后采集JF、PT和SF样本，对所有样本进行培养和广谱PCR检测。
SF培养（83.0%）、JF-PCR（83.0%）和SF-PCR（84.9%）的敏感性相似（P>0.05），但均显著高于JF培养（69.8%）、PT培养（71.7%）和PT-PCR（34.0%）（P<0.05）。JF培养、PT培养、SF培养、JF-PCR、PT-PCR和SF-PCR的特异性相似（分别为100%、100%、85.7%、85.7%、100%和78.6%）（P>0.05）。PCR无法准确检测出6例混合感染和2例真菌感染。
对于停用抗生素两周或更长时间的患者，SF培养、JF-PCR和SF-PCR在诊断PJI方面比JF培养、PT培养和PT-PCR更敏感。与PCR方法相比，SF培养在检测混合感染或真菌感染方面具有优势。PT-PCR的敏感性不足以提供正确诊断。
