化脓性关节炎和假体周围关节感染微生物鉴定中的多重 PCR：新分子检测诊断算法的应用结果。

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2024-07-21 DOI:10.1002/jeo2.12097

Stefano Ghirardelli, Federica Scaggiante, Christina Troi, Pieralberto Valpiana, Giovanni Cristofolini, Giuseppe Aloisi, Bruno Violante, Arcangelo Russo, Sebastian Schaller, Pier F. Indelli

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引用次数: 0

摘要

目的：病原体鉴定是治疗化脓性关节炎（SA）和假体周围关节感染（PJI）的关键。本研究评估了基于评分的新型化脓性关节炎和假体周围关节感染诊断算法的应用效果，该算法包括对滑膜液进行分子检测：一种基于评分的诊断算法，包括使用多重 PCR (mPCR) 和下一代测序 (NGS) 分子检测进行血清学和滑液标记物测定，已应用于临床疑似 SA 或 PJI 患者的连续系列。评分≥6分的患者接受滑液分子检测和传统培养，以确定病原体及其基因决定的抗生素耐药性：117名患者（62.5%为女性，平均年龄73岁）的117个关节符合SA/PJI的可能标准。87.5%的患者受影响的关节是膝关节（关节置换 66.5%；原生关节 21%），12.5%的患者受影响的关节是髋关节（所有关节均被置换）。43/117 名患者（36.7%）最终被诊断为 SA/PJI。在应用的各种检测技术中，mPCR 是鉴定病原体的主要决定因素，占 63%，标准培养占 26%，mNGS 占 11%。金黄色葡萄球菌和粪肠球菌是 mPCR 鉴定的前两种微生物，而表皮葡萄球菌则是 NGS 鉴定的主要微生物。mPCR 鉴定病原体的平均时间为 3.13 小时，培养为 4.5 天，NGS 为 3.2 天：分子诊断技术是一种创新的筛查方法，可在临床怀疑关节感染时快速鉴定微生物：证据等级：IV 级，病例系列。

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Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the application of a new molecular testing diagnostic algorithm

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Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the application of a new molecular testing diagnostic algorithm

Purpose

Pathogen identification is key in the treatment of septic arthritis (SA) and periprosthetic joint infections (PJI). This study evaluates the outcome of the application of a new, score-based SA and PJI diagnostic algorithm, which includes the execution of molecular testing on synovial fluid.

Methods

A score-based diagnostic algorithm, which includes serologic and synovial fluid markers determination using multiplex PCR (mPCR) and Next Generation Sequencing (NGS) molecular testing, has been applied to a consecutive series of patients with clinically suspected SA or PJI. Patients with a score ≥6 underwent synovial fluid molecular testing, together with traditional culture, to identify the pathogen and its genetically determined antibiotic resistance.

Results

One hundred and seventeen joints in 117 patients (62.5% women; average age 73 years) met the criteria for possible SA/PJI. The affected joint was the knee in 87.5% (joint replacement 66.5%; native joint 21%) and the hip in 12.5% (all replaced joints). 43/117 patients (36.7%) were ultimately diagnosed with SA/PJI. Among the various testing technologies applied, mPCR was the main determinant for pathogen identification in 63%, standard culture in 26%, and mNGS in 11%. Staphylococcus aureus and Enterococcus faecalis were the top two microorganisms identified by mPCR, while Staphylococcus epidermidis was the prevalent organism identified by NGS. mPCR detected the presence/absence of the genetically determined antibiotic resistance of all identified microorganisms. The average timeframe for pathogen identification was 3.13 h for mPCR, 4.5 days for culture, and 3.2 days for NGS.

Conclusions

Molecular diagnostic technologies represent an innovative screening for fast microorganism identification when a joint infection is clinically suspected.