定量实时聚合酶链反应在检测肩肱关节痤疮丙酸杆菌中可作为传统培养的有用辅助手段：对100例连续患者的研究
Quantitative Real-Time Polymerase Chain Reaction May Serve as a Useful Adjunct to Conventional Culture in The Detection of Cutibacterium acnes in the Glenohumeral Joint: A Study of 100 Consecutive Patients.
作者信息
Como Matthew, Reddy Rajiv P, Hankins Margaret L, Kane Gillian E, Ma Dongzhu, Alexander Peter G, Urish Kenneth L, Karimi Amin, Lin Albert
出版信息
Arch Bone Jt Surg. 2024;12(2):102-107. doi: 10.22038/ABJS.2023.70190.3295.
OBJECTIVES
Synovial fluid or tissue culture is the current gold standard for diagnosis of infection, but Cutibacterium acnes (C. acnes) is a frequent cause of shoulder PJI and is a notoriously fastidious organism. The purpose of this study was to compare quantitative real-time polymerase chain reaction (qRT-PCR) to standard culture as a more rapid, sensitive means of identifying C. acnes from the glenohumeral joint. We hypothesized that qRT-PCR would be more effective than standard culture at identifying C. acnes and would have greater sensitivity and specificity for detecting infection.
METHODS
This was a prospective observational study with 100 consecutive patients undergoing arthroscopic or open shoulder surgery with known positive and negative controls. Intraoperatively, synovial fluid and tissue was obtained for C. acnes qRT-PCR and results were blinded to the gold standard microbiology cultures.
RESULTS
Clinical review demonstrated 3 patients (3%) with positive cultures, none of which were positive for C. acnes. Of the samples tested by the C. acnes qRT-PCR standard curve, 12.2% of tissue samples and 4.5% of fluid samples were positive. Culture sensitivity was 60.0%, specificity was 100.0%, PPV was 100.0%, and NPV was 97.9%. C. acnes qRT-PCR standard curve sensitivity, specificity, PPV, and NPV was 60.0%, 90.3%, 25.0%, and 97.7% respectively for tissue specimens and 0%, 95.2%, 0%, and 95.2% respectively, for fluid specimens. For combination of culture and tissue qRT-PCR, the sensitivity, specificity, PPV and NPV was 100%, 90.3%, 35.7%, and 100%, respectively.
CONCLUSION
We report that qRT-PCR for C. acnes identified the organism more frequently than conventional culture. While these findings demonstrate the potential utility of qRT-PCR, the likelihood of false positive results of qRT-PCR should be considered. Thus, qRT-PCR may be useful as an adjuvant to current gold standard workup of synovial fluid or tissue culture for the diagnosis of infection.
目的
滑液或组织培养是目前感染诊断的金标准，但痤疮丙酸杆菌是肩关节假体周围感染（PJI）的常见病因，且是一种极难培养的微生物。本研究的目的是将定量实时聚合酶链反应（qRT-PCR）与标准培养法进行比较，作为一种从盂肱关节中鉴定痤疮丙酸杆菌的更快速、灵敏的方法。我们假设qRT-PCR在鉴定痤疮丙酸杆菌方面比标准培养法更有效，并且在检测感染方面具有更高的敏感性和特异性。
方法
这是一项前瞻性观察性研究，对100例连续接受关节镜或开放性肩部手术的患者进行研究，设有已知的阳性和阴性对照。术中获取滑液和组织进行痤疮丙酸杆菌qRT-PCR检测，结果对金标准微生物培养结果设盲。
结果
临床检查显示3例（3%）培养结果为阳性，但均非痤疮丙酸杆菌阳性。在通过痤疮丙酸杆菌qRT-PCR标准曲线检测的样本中，12.2%的组织样本和4.5%的液体样本为阳性。培养的敏感性为60.0%，特异性为100.0%，阳性预测值（PPV）为100.0%，阴性预测值（NPV）为97.9%。痤疮丙酸杆菌qRT-PCR标准曲线对组织标本的敏感性、特异性、PPV和NPV分别为60.0%、90.3%、25.0%和97.7%，对液体标本分别为0%、95.2%、0%和95.2%。对于培养和组织qRT-PCR的联合检测，敏感性、特异性、PPV和NPV分别为100%、90.3%、35.7%和100%。
结论
我们报告，痤疮丙酸杆菌的qRT-PCR比传统培养法更频繁地鉴定出该微生物。虽然这些发现证明了qRT-PCR的潜在效用，但应考虑qRT-PCR假阳性结果的可能性。因此，qRT-PCR作为目前滑液或组织培养金标准检查的辅助手段，可能对感染诊断有用。
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