Institute of Pathology (T.L., P.B., M.K., F.L., and D.J.) and Department of Orthopaedic Surgery (M.E.), Hannover Medical School (MHH), Hannover, Germany.
Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (Deutsches Zentrum für Lungenforschung [DZL]), Hannover, Germany.
J Bone Joint Surg Am. 2019 Jan 16;101(2):e5. doi: 10.2106/JBJS.18.00243.
As the number of arthroplasties performed increases, periprosthetic joint infection (PJI) represents a common and challenging problem. The Musculoskeletal Infection Society (MSIS) recommends diagnosing PJI according to its guidelines. The aim of the current study was to assess whether fluorescence in situ hybridization (FISH) analysis of formalin-fixed paraffin-embedded periprosthetic membranes can successfully improve the diagnosis of infection in patients with orthopaedic implants.
We retrospectively analyzed 88 periprosthetic membranes of joint prostheses using FISH analysis according to a standard protocol, with a probe targeting a sequence found in most bacteria. We compared the results with routine clinical classification according to the guidelines of the MSIS, microbiological culture, and histopathological classification according to Morawietz and Krenn. We additionally performed FISH analysis using 2 species-specific probes for several culture-positive cases.
FISH successfully detected bacteria in 38 (95%) of 40 periprosthetic membranes that were rated positive by clinical classification. FISH results compared with clinical classification demonstrated a sensitivity of 95% (95% confidence interval [CI], 83.08% to 99.39%), a specificity of 85.42% (95% CI, 72.24% to 93.93%), a positive predictive value of 84.44% (95% CI, 70.55% to 93.50%), and a negative predictive value of 95.35% (95% CI, 84.19% to 99.43%). FISH results compared with histopathological classification demonstrated a sensitivity of 95.12% (95% CI, 83.47% to 99.40%), a specificity of 87.23% (95% CI, 74.26% to 95.17%), a positive predictive value of 86.67% (95% CI, 73.21% to 94.95%), and a negative predictive value of 95.35% (95% CI, 84.19% to 99.43%). We successfully detected Pseudomonas aeruginosa and Staphylococcus aureus with species-specific FISH probes in all cases that were positive for these respective bacteria by microbiological culture.
FISH-based diagnosis of PJI is feasible and can be used as an additional diagnostic criterion. FISH not only can detect bacteria in periprosthetic membranes but can also differentiate pathogens at the species level. FISH represents a fast and reliable tool for detecting PJI in periprosthetic membranes, especially in combination with clinical and histopathological classification.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
随着关节置换手术数量的增加，假体周围关节感染（PJI）成为一个常见且具有挑战性的问题。肌肉骨骼感染学会（MSIS）建议根据其指南诊断 PJI。本研究旨在评估福尔马林固定石蜡包埋假体周围膜的荧光原位杂交（FISH）分析是否能成功提高骨科植入物患者感染的诊断率。
我们按照标准方案，对 88 个关节假体的假体周围膜进行了 FISH 分析，使用了靶向大多数细菌中存在的序列的探针。我们将结果与 MSIS 指南规定的常规临床分类、微生物培养和 Morawietz 和 Krenn 的组织病理学分类进行了比较。我们还对一些培养阳性的病例使用了 2 种针对特定物种的探针进行了 FISH 分析。
FISH 成功检测到了 38 个（95%）临床分类为阳性的假体周围膜中的细菌。FISH 结果与临床分类的比较显示，其灵敏度为 95%（95%置信区间[CI]，83.08%99.39%），特异性为 85.42%（95%CI，72.24%93.93%），阳性预测值为 84.44%（95%CI，70.55%93.50%），阴性预测值为 95.35%（95%CI，84.19%99.43%）。FISH 结果与组织病理学分类的比较显示，其灵敏度为 95.12%（95%CI，83.47%99.40%），特异性为 87.23%（95%CI，74.26%95.17%），阳性预测值为 86.67%（95%CI，73.21%94.95%），阴性预测值为 95.35%（95%CI，84.19%99.43%）。我们使用针对特定物种的 FISH 探针，成功地在所有经微生物培养证实为相应细菌阳性的病例中检测到铜绿假单胞菌和金黄色葡萄球菌。
基于 FISH 的 PJI 诊断是可行的，可作为额外的诊断标准。FISH 不仅可以检测假体周围膜中的细菌，还可以区分物种水平的病原体。FISH 是一种快速可靠的检测假体周围膜 PJI 的工具，尤其是与临床和组织病理学分类相结合时。
诊断 III 级。有关证据水平的完整描述，请参见作者指南。
