Multiplex PCR in Septic Arthritis and Periprosthetic Joint Infections Microorganism Identification: Results from the Application of a New Molecular Testing Diagnostic Algorithm

Overview

Journal J Exp Orthop

Publisher Wiley

Specialty Orthopedics

Date 2024 Jul 22

PMID 39035845

Authors

Stefano Ghirardelli

Federica Scaggiante

Christina Troi

Pieralberto Valpiana

Giovanni Cristofolini

Giuseppe Aloisi

Bruno Violante

Arcangelo Russo

Sebastian Schaller

Pier F Indelli

Affiliations

Soon will be listed here.

Abstract

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%. and were the top two microorganisms identified by mPCR, while 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.

Level Of Evidence: Level IV, case series.

Citing Articles

Diagnosis and Treatment of Acute Periprosthetic Infections with the BioFire System within a Time-Dependent and Bacterium-Dependent Protocol: Review and Prosthesis-Saving Protocol.

Sangaletti R, Andriollo L, Montagna A, Franzoni S, Colombini P, Perticarini L Biomedicines. 2024; 12(9).

PMID: 39335595 PMC: 11428812. DOI: 10.3390/biomedicines12092082.

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