Unyvero i60 implant and tissue infection (ITI) multiplex PCR system in diagnosing periprosthetic joint infection

• Published in: Journal of microbiological methods 2016-02, Vol.121, p.27-32
• Main Authors: Hischebeth, Gunnar T.R., Randau, Thomas M., Buhr, Johanna K., Wimmer, Matthias D., Hoerauf, Achim, Molitor, Ernst, Bekeredjian-Ding, Isabelle, Gravius, Sascha
• Format: Article
• Language: English
• Subjects: Arthritis, Infectious - diagnosis; Bacteriological Techniques - instrumentation; Bacteriological Techniques - methods; Culture Techniques; DNA, Bacterial - genetics; Gram positive; Gram-Positive Bacteria - isolation & purification; Humans; Multiplex Polymerase Chain Reaction - instrumentation; Multiplex Polymerase Chain Reaction - methods; Multiplex-PCR; PCR; Periprosthetic joint infection; Predictive Value of Tests; Prospective Studies; Prostheses and Implants - microbiology; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - microbiology; Sensitivity and Specificity; Sonication; Sonication - methods; Staphylococci; Synovial Fluid - microbiology
• ISSN: 0167-7012; 1872-8359
• DOI: 10.1016/j.mimet.2015.12.010

Periprosthetic joint infection (PJI) is one of the most challenging complications in orthopedic surgery. In cases of suspected periprosthetic joint infection several diagnostic methods are available. In this study we investigated the performance of the newly available Unyvero i60 implant and tissue infection (ITI) multiplex PCR System. 62 specimens from 31 patients with suspected PJI or aseptic loosening of a painful joint arthoplasty were included in this study. Besides the established diagnostic procedures we included a commercial multiplex PCR detection system for diagnosis of PJI. The PCR results obtained from analysis of sonication and synovial fluids (62 specimens) showed a sensitivity of 66.7%, a specificity of 100%, a positive predictive value (PPV) of 100% and a negative predictive value (NPV) of 68.4% when compared to cultural methods. Notably, cultures from sonication fluid displayed a sensitivity of 88.9%, a specificity of 61.5%, a PPV of 76.2% and a NPV of 80.0% when compared to tissue cultures. In conclusion, multiplex PCR is an additional – rapid – method for diagnosing PJI. Positive results with the PCR assay used in this study were always confirmed by subsequent matching culture positivity. However, apart from the time saved the nucleic acid amplification technique did not yield additional information than that obtained from microbiological cultures. •Sonication fluid cultures showed the highest sensitivity in our cohort.•Positive PCR results were always confirmed by culture techniques.•PCR diagnostic is an additional method that can provide results at a very early stage.