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Gardete-Hartmann S, Mitterer JA, Sebastian S, Frank BJH, Simon S, Huber S, Löw M, Sommer I, Prinz M, Halabi M, Hofstaetter JG. The role of BioFire Joint Infection Panel in diagnosing periprosthetic hip and knee joint infections in patients with unclear conventional microbiological results. Bone Joint Res 2024; 13:353-361. [PMID: 38981611 PMCID: PMC11233181 DOI: 10.1302/2046-3758.137.bjr-2023-0321.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Abstract
Aims This study aimed to evaluate the BioFire Joint Infection (JI) Panel in cases of hip and knee periprosthetic joint infection (PJI) where conventional microbiology is unclear, and to assess its role as a complementary intraoperative diagnostic tool. Methods Five groups representing common microbiological scenarios in hip and knee revision arthroplasty were selected from our arthroplasty registry, prospectively maintained PJI databases, and biobank: 1) unexpected-negative cultures (UNCs), 2) unexpected-positive cultures (UPCs), 3) single-positive intraoperative cultures (SPCs), and 4) clearly septic and 5) aseptic cases. In total, 268 archived synovial fluid samples from 195 patients who underwent acute/chronic revision total hip or knee arthroplasty were included. Cases were classified according to the International Consensus Meeting 2018 criteria. JI panel evaluation of synovial fluid was performed, and the results were compared with cultures. Results The JI panel detected microorganisms in 7/48 (14.5%) and 15/67 (22.4%) cases related to UNCs and SPCs, respectively, but not in cases of UPCs. The correlation between JI panel detection and infection classification criteria for early/late acute and chronic PJI was 46.6%, 73%, and 40%, respectively. Overall, the JI panel identified 12.6% additional microorganisms and three new species. The JI panel pathogen identification showed a sensitivity and specificity of 41.4% (95% confidence interval (CI) 33.7 to 49.5) and 91.1% (95% CI 84.7 to 94.9), respectively. In total, 19/195 (9.7%) could have been managed differently and more accurately upon JI panel evaluation. Conclusion Despite its microbial limitation, JI panel demonstrated clinical usefulness by complementing the traditional methods based on multiple cultures, particularly in PJI with unclear microbiological results.
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Affiliation(s)
- Susana Gardete-Hartmann
- Michael Ogon Laboratory for Orthopaedic Research Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Jennyfer A Mitterer
- Michael Ogon Laboratory for Orthopaedic Research Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Sujeesh Sebastian
- Michael Ogon Laboratory for Orthopaedic Research Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Bernhard J H Frank
- Michael Ogon Laboratory for Orthopaedic Research Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Sebastian Simon
- Michael Ogon Laboratory for Orthopaedic Research Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Stephanie Huber
- Michael Ogon Laboratory for Orthopaedic Research Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Marcellino Löw
- Michael Ogon Laboratory for Orthopaedic Research Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Ian Sommer
- Michael Ogon Laboratory for Orthopaedic Research Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | | | - Milo Halabi
- Institute for Pathology, Microbiology and Molecular Diagnostic, Hospital of the Sisters of Charity, Ried, Austria
| | - Jochen G Hofstaetter
- Michael Ogon Laboratory for Orthopaedic Research Orthopaedic Hospital Vienna-Speising, Vienna, Austria
- 2nd Department, Orthopaedic Hospital Speising, Vienna, Austria
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Li H, Fu J, Erlong N, Li R, Xu C, Hao L, Chen J, Chai W. Characterization of periprosthetic environment microbiome in patients after total joint arthroplasty and its potential correlation with inflammation. BMC Infect Dis 2023; 23:423. [PMID: 37349686 DOI: 10.1186/s12879-023-08390-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/08/2023] [Indexed: 06/24/2023] Open
Abstract
AIMS Periprosthetic joint infection (PJI) is one of the most serious complications after total joint arthroplasty (TJA) but the characterization of the periprosthetic environment microbiome after TJA remains unknown. Here, we performed a prospective study based on metagenomic next-generation sequencing to explore the periprosthetic microbiota in patients with suspected PJI. METHODS We recruited 28 patients with culture-positive PJI, 14 patients with culture-negative PJI, and 35 patients without PJI, which was followed by joint aspiration, untargeted metagenomic next-generation sequencing (mNGS), and bioinformatics analysis. Our results showed that the periprosthetic environment microbiome was significantly different between the PJI group and the non-PJI group. Then, we built a "typing system" for the periprosthetic microbiota based on the RandomForest Model. After that, the 'typing system' was verified externally. RESULTS We found the periprosthetic microbiota can be classified into four types generally: "Staphylococcus type," "Pseudomonas type," "Escherichia type," and "Cutibacterium type." Importantly, these four types of microbiotas had different clinical signatures, and the patients with the former two microbiota types showed obvious inflammatory responses compared to the latter ones. Based on the 2014 Musculoskeletal Infection Society (MSIS) criteria, clinical PJI was more likely to be confirmed when the former two types were encountered. In addition, the Staphylococcus spp. with compositional changes were correlated with C-reactive protein levels, the erythrocyte sedimentation rate, and the synovial fluid white blood cell count and granulocyte percentage. CONCLUSIONS Our study shed light on the characterization of the periprosthetic environment microbiome in patients after TJA. Based on the RandomForest model, we established a basic "typing system" for the microbiota in the periprosthetic environment. This work can provide a reference for future studies about the characterization of periprosthetic microbiota in periprosthetic joint infection patients.
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Affiliation(s)
- Hao Li
- Medical School of Chinese PLA, Beijing, People's Republic of China
- Department of Orthopedic Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China
| | - Jun Fu
- Department of Orthopedic Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China
| | - Niu Erlong
- Department of Orthopedics, 305 Hospital of PLA, Beijing, People's Republic of China
| | - Rui Li
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Chi Xu
- Department of Orthopedic Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China
| | - Libo Hao
- Department of Orthopedic Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China
| | - Jiying Chen
- Department of Orthopedic Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China.
| | - Wei Chai
- Department of Orthopedic Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China.
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China.
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Bos MP, van Houdt R, Poort L, van der Stel AX, Peters EJ, Saouti R, Savelkoul P, Budding AE. Rapid Diagnostics of Joint Infections Using IS-Pro. J Clin Microbiol 2023; 61:e0015423. [PMID: 37154734 PMCID: PMC10281151 DOI: 10.1128/jcm.00154-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023] Open
Abstract
Diagnosis of bone and joint infections (BJI) relies on microbiological culture which has a long turnaround time and is challenging for certain bacterial species. Rapid molecular methods may alleviate these obstacles. Here, we investigate the diagnostic performance of IS-pro, a broad-scope molecular technique that can detect and identify most bacteria to the species level. IS-pro additionally informs on the amount of human DNA present in a sample, as a measure of leukocyte levels. This test can be performed in 4 h with standard laboratory equipment. Residual material of 591 synovial fluid samples derived from native and prosthetic joints from patients suspected of joint infections that were sent for routine diagnostics was collected and subjected to the IS-pro test. Bacterial species identification as well as bacterial load and human DNA load outcomes of IS-pro were compared to those of culture. At sample level, percent positive agreement (PPA) between IS-pro and culture was 90.6% (95% CI 85.7- to 94%) and negative percent agreement (NPA) was 87.7% (95% CI 84.1 to 90.6%). At species level PPA was 80% (95% CI 74.3 to 84.7%). IS-pro yielded 83 extra bacterial detections over culture for which we found supporting evidence for true positivity in 40% of the extra detections. Missed detections by IS-pro were mostly related to common skin species in low abundance. Bacterial and human DNA signals measured by IS-pro were comparable to bacterial loads and leukocyte counts reported by routine diagnostics. We conclude that IS-pro showed an excellent performance for fast diagnostics of bacterial BJI.
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Affiliation(s)
| | - Robin van Houdt
- Department of Medical Microbiology & Infection Control, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Edgar J. Peters
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Infectious Diseases, Amsterdam Infection & Immunity, Infectious Diseases, Amsterdam, The Netherlands
| | - Rachid Saouti
- Department of Orthopedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Savelkoul
- Department of Medical Microbiology & Infection Control, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht UMC, Maastricht, The Netherlands
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Han HS, Ro DH, Chung J, Kim N, Moon J. Nanopore 16S amplicon sequencing enables rapid detection of pathogen in knee periprosthetic joint infection. Int J Med Microbiol 2022; 312:151570. [PMID: 36288682 DOI: 10.1016/j.ijmm.2022.151570] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES We investigated whether nanopore 16S amplicon sequencing is capable of bacterial identification in patients with knee prosthetic joint infection (PJI), and we compared its efficacy with conventional culture studies. METHODS In total, 36 patients who had clinical manifestation suspected of PJI were enrolled in this study. To begin, synovial fluids were aspirated from the affected knee using aseptic technique and tissues specimens were obtained during the surgery. Next, DNA was extracted from the synovial fluid or tissues, and 16S rDNA PCR was performed. In PCR positive cases, nanopore amplicon sequencing was then performed for up to 3 h. The results of amplicon sequencing were compared to those of conventional culture studies. RESULTS Of the 36 patients enrolled, 22 were classified as true infections according to the MSIS criteria whereas 14 were considered uninfected. Among the 22 PJI cases, 19 cases were culture positive (CP-PJI) while three cases were culture negative (CN-PJI). In 14 of 19 (73.7 %) CP- PJI cases, 16S sequencing identified concordant bacteria with conventional culture studies with a significantly shorter turnaround time. In some cases, nanopore 16S sequencing was superior to culture studies in the species-level identification of pathogen and detection of polymicrobial infections. Altogether, in the majority of PJI candidate patients (32 of 36, 88.9 %), 16S sequencing achieved identical results to cultures studies with a significantly reduced turnaround time (100.9 ± 32.5 h vs. 10.8 ± 7.7 h, p < 0.001). CONCLUSIONS Nanopore 16S sequencing was found to be particularly useful for pathogen identification in knee PJI. Although the sensitivity was not superior to culture studies, the nanopore 16S sequencing was much faster, and species-level identification and detection of polymicrobial infections were superior to culture studies.
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Affiliation(s)
- Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeehyeok Chung
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Narae Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea; Department of Genomic Medicine, Seoul National University Hospital, Seoul, South Korea.
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Liu X, Min HS, Chai Y, Yu X, Wen G. Masquelet technique with radical debridement and alternative fixation in treatment of infected bone nonunion. Front Surg 2022; 9:1000340. [PMID: 36299571 PMCID: PMC9589492 DOI: 10.3389/fsurg.2022.1000340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Infected bone nonunion is the toughest problem in fracture-related infection, leading to high disability and recurrence. The aim of this study was to evaluate the effectiveness of the Masquelet technique with radical debridement and alternative fixation in the management of infected bone nonunion. Patients and Methods A retrospective study of prospectively collected data in two trauma centers was performed from 2016 to 2020. Patients diagnosed as infected bone nonunion were included in this study. The initial implant was removed and all patients received a two-stage Masquelet procedure with radical debridement and alternative fixation. The disappearance of inflammatory manifestations and regression of infection indicators (such as interleukin-6 (IL-6), C-reactive protein, white blood cell count) to the normal range were regarded as radical debridement. The alternative fixation depended on local soft tissue conditions. Results were evaluated according to clinical and radiographic assessment and patient satisfaction. Results A total of 23 patients were included in our study. Six of them received internal fixation, while the other 17 received external fixation. Of the 23 cases, 21 were successfully reconstructed without infection recurrence, except 2 reinfected cases. Mean full weight bearing time was 6.6 months follow-up post last surgery. Out of the 23, 20 cases had satisfactory functional outcomes without additional bone or soft tissue comorbidities. Discrepancies in leg length and joint stiffness were observed in three cases and marked as unsatisfied results. Conclusions Infected bone nonunion can be successfully managed using the Masquelet technique under radical debridement combined with an alternative fixation method.
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Affiliation(s)
| | | | | | | | - Gen Wen
- Correspondence: Xiaowei Yu Gen Wen
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El Sayed F, Jeverica S, Roux AL, Bauer T, Nkam L, Sivadon-Tardy V, Noussair L, Herrmann JL, Gaillard JL, Rak M, Papst L, Rottman M. Cutibacterium acnes clonal complexes display various growth rates in blood culture vials used for diagnosing orthopedic device-related infections. Anaerobe 2021; 72:102469. [PMID: 34699978 DOI: 10.1016/j.anaerobe.2021.102469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/17/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Blood culture bottles (BCBs) are commonly used for the diagnosis of infections associated with orthopedic devices. Although Cutibacterium acnes is an important pathogen in orthopedics, relatively little is known about its growth characteristics in BCBs. This prompted us to analyze the influence of bacterial genotype and clinical significance on time-to-detection (TTD) in BCBs. METHODS We reviewed 59 cases of orthopedic device-related infections in which at least one intraoperative specimen yielded a pure C. acnes culture from anaerobic BCBs (BD Bactec Lytic/10 Anaerobic/F; Lytic-Ana) and/or solid media. A strain was considered infectant if the same genotype was present in two or more intraoperative samples. From these cases, we isolated a total of 72 unique C. acnes strains belonging to four multilocus sequence type clonal complexes (CCs): CC18, CC28, CC36 and CC53. Growth rate and TTD in Lytic-Ana BCB were studied under experimental conditions (inoculation of standard inoculum) and in clinical samples (inoculation of periprosthetic tissue samples). RESULTS Median TTD values were shorter for CC53 compared to other CCs under experimental conditions (69 vs. 103 h; p < 0.001) and from clinical specimens (70 vs. 200 h; p = 0.02). Infectant strains had a shorter median TTD compared to contaminant strains in a clinical situation, while the difference was not observed under experimental conditions. CONCLUSIONS The detection dynamics of C. acnes in Lytic-Ana BCBs were associated with genotype. Thus, TTD not only reflects the bacterial load in clinical samples, but may also reflect the intrinsic properties of the clonal complex of C. acnes.
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Affiliation(s)
- Faten El Sayed
- APHP, GHU Paris Saclay, Hôpital Ambroise Paré, Microbiology Department, Boulogne-Billancourt, France; Université Paris-Saclay, UVSQ, Inserm, Infection et Inflammation, Montigny-Le-Bretonneux, France.
| | - Samo Jeverica
- National Laboratory of Health, Environment and Food, Maribor, Slovenia
| | - Anne-Laure Roux
- APHP, GHU Paris Saclay, Hôpital Ambroise Paré, Microbiology Department, Boulogne-Billancourt, France; Université Paris-Saclay, UVSQ, Inserm, Infection et Inflammation, Montigny-Le-Bretonneux, France
| | - Thomas Bauer
- APHP, GHU Paris Saclay, Hôpital Ambroise Paré, Orthopedic Surgery Department, Boulogne-Billancourt, France
| | - Lionelle Nkam
- Clinical Research Unit, APHP Paris Saclay Ouest, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Valérie Sivadon-Tardy
- APHP, GHU Paris Saclay, Hôpital Ambroise Paré, Microbiology Department, Boulogne-Billancourt, France
| | - Latifa Noussair
- APHP, GHU Paris Saclay, Hôpital Raymond Poincaré, Microbiology Department, Garches, France
| | - Jean-Louis Herrmann
- Université Paris-Saclay, UVSQ, Inserm, Infection et Inflammation, Montigny-Le-Bretonneux, France; APHP, GHU Paris Saclay, Hôpital Raymond Poincaré, Microbiology Department, Garches, France
| | - Jean-Louis Gaillard
- APHP, GHU Paris Saclay, Hôpital Ambroise Paré, Microbiology Department, Boulogne-Billancourt, France; Université Paris-Saclay, UVSQ, Inserm, Infection et Inflammation, Montigny-Le-Bretonneux, France
| | - Mitja Rak
- National Laboratory of Health, Environment and Food, Maribor, Slovenia
| | - Lea Papst
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Martin Rottman
- Université Paris-Saclay, UVSQ, Inserm, Infection et Inflammation, Montigny-Le-Bretonneux, France; APHP, GHU Paris Saclay, Hôpital Raymond Poincaré, Microbiology Department, Garches, France
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