Orthopedics. 2020 Nov 1;43(6):333-338. doi: 10.3928/01477447-20200923-01. Epub 2020 Oct 1.
The use of genetic sequencing modalities in the diagnosis of periprosthetic joint infection (PJI) and the identification of organisms has gained popularity recently. Polymerase chain reaction (PCR) offers timely results for common organisms. The purpose of this study was to compare the accuracy of broad-range PCR, conventional culture, the Musculoskeletal Infection Society (MSIS) criteria, and the recently proposed criteria by Parvizi et al in the diagnosis of PJI. In this retrospective study, aspirate or tissue samples were collected in 104 revision and 86 primary arthroplasties for routine diagnostic workup for PJI and sent to the laboratory for PCR. Concordance along with statistical differences between diagnostic studies were calculated using chi-square test for categorical data. On comparison with the MSIS criteria, concordance was significantly lower for PCR at 64.7% compared with 86.3% for culture (P<.001). There was no significant difference based on diagnosis of prior infection (P=.706) or sample collection method (tissue swab or synovial fluid) (P=.316). Of the 87 patients who met MSIS criteria, only 20 (23.0%) PCR samples had an organism identified. In this series, PCR had little utility as a stand-alone test for the diagnosis of PJI, with a sensitivity of only 23.0% when using MSIS criteria as the gold standard. Polymerase chain reaction also appears to be significantly less accurate than culture in the diagnosis of PJI. Currently, several laboratory tests used for either criteria for PJI diagnosis should be obtained along with the overall clinical picture to help guide decision-making for PJI treatment. [Orthopedics. 2020;43(6):333-338.].
近年来，基因测序模式在诊断假体周围关节感染（PJI）和鉴定病原体方面得到了广泛应用。聚合酶链反应（PCR）为常见病原体提供了及时的结果。本研究的目的是比较广谱 PCR、常规培养、肌肉骨骼感染学会（MSIS）标准以及 Parvizi 等人最近提出的标准在诊断 PJI 中的准确性。在这项回顾性研究中，为了进行 PJI 的常规诊断性检查，从 104 例翻修和 86 例初次关节置换术中收集了抽吸物或组织样本，并送到实验室进行 PCR。使用卡方检验比较诊断研究之间的一致性和统计学差异。与 MSIS 标准相比，PCR 的一致性明显较低，为 64.7%，而培养的一致性为 86.3%（P<.001）。基于先前感染的诊断（P=.706）或样本采集方法（组织拭子或滑液）（P=.316），差异无统计学意义。在符合 MSIS 标准的 87 名患者中，只有 20 名（23.0%）PCR 样本鉴定出病原体。在本系列中，PCR 作为 PJI 诊断的独立检测方法几乎没有用处，当使用 MSIS 标准作为金标准时，其敏感性仅为 23.0%。PCR 在诊断 PJI 方面似乎也明显不如培养准确。目前，在获得用于 PJI 诊断的标准的同时，还应获得其他几种实验室检测结果，结合整体临床情况，有助于指导 PJI 治疗的决策。[骨科。2020;43(6):333-338.]。
