Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92 cases
Background The diagnosis of prosthetic infection remains a challenge, as no test is 100% sensitive and 100% specific Recent advances in molecular biology have enabled the detection of infection in culture negative cases. Patients and methods We evaluated the effectiveness of polymerase chain reactio...
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| Veröffentlicht in: | Acta orthopaedica 2005-06, Vol.76 (3), p.341-346 |
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| creator | Panousis, Konstantinos Grigoris, Peter Butcher, Ian Rana, Bardeep Reilly, James H Hamblen, David L |
| description | Background The diagnosis of prosthetic infection remains a challenge, as no test is 100% sensitive and 100% specific Recent advances in molecular biology have enabled the detection of infection in culture negative cases.
Patients and methods We evaluated the effectiveness of polymerase chain reaction (PCR) in detecting infection in failed joint replacements prospectively in 91 consecutive patients (92 prosthetic joints) undergoing revision total hip or knee arthroplasty. Synovial fluid was collected intraoperatively and examined by broad-range PCR assay for detection of bacterial DNA. The clinical diagnosis of infection was based on the results of blood tests, preoperative joint aspiration, culture and histology of multiple intraoperative tissue samples, as well as the surgeon's assessment.
12 joints (13%) were infected, but the PCR was positive in 32 cases. The sensitivity of the technique was 92%, the specificity 74%, the accuracy 76%, the positive predictive value 34%, and the negative predictive value was 98%.
Interpretation The PCR technique cannot be recommended for the routine detection of prosthetic infection. The large number of false positive results may represent sample contamination, or bacterial presence related to low-virulence organisms, low bacterial load, or a strong host immune response. |
| doi_str_mv | 10.1080/00016470510030805 |
| format | Article |
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Patients and methods We evaluated the effectiveness of polymerase chain reaction (PCR) in detecting infection in failed joint replacements prospectively in 91 consecutive patients (92 prosthetic joints) undergoing revision total hip or knee arthroplasty. Synovial fluid was collected intraoperatively and examined by broad-range PCR assay for detection of bacterial DNA. The clinical diagnosis of infection was based on the results of blood tests, preoperative joint aspiration, culture and histology of multiple intraoperative tissue samples, as well as the surgeon's assessment.
12 joints (13%) were infected, but the PCR was positive in 32 cases. The sensitivity of the technique was 92%, the specificity 74%, the accuracy 76%, the positive predictive value 34%, and the negative predictive value was 98%.
Interpretation The PCR technique cannot be recommended for the routine detection of prosthetic infection. The large number of false positive results may represent sample contamination, or bacterial presence related to low-virulence organisms, low bacterial load, or a strong host immune response.</description><identifier>ISSN: 1745-3674</identifier><identifier>EISSN: 1745-3682</identifier><identifier>DOI: 10.1080/00016470510030805</identifier><identifier>PMID: 16156461</identifier><language>eng</language><publisher>Basingstoke: Informa UK Ltd</publisher><subject>Arthroplasty, Replacement, Hip - adverse effects ; Arthroplasty, Replacement, Knee - adverse effects ; Bacterial Infections - diagnosis ; Bacterial Infections - microbiology ; Biological and medical sciences ; Diseases of the osteoarticular system ; DNA, Bacterial - analysis ; False Positive Reactions ; Humans ; Medical sciences ; Miscellaneous. Osteoarticular involvement in other diseases ; Orthopedic surgery ; Polymerase Chain Reaction - standards ; Predictive Value of Tests ; Prospective Studies ; Prosthesis Failure ; Prosthesis-Related Infections - diagnosis ; Prosthesis-Related Infections - microbiology ; Reoperation ; Sensitivity and Specificity ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Synovial Fluid - microbiology</subject><ispartof>Acta orthopaedica, 2005-06, Vol.76 (3), p.341-346</ispartof><rights>2005 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted 2005</rights><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c500t-9c4d5a61f296b43ebd3b9cd8c7eb27048309a404491b7ac1d1bd92c2184d4fa03</citedby><cites>FETCH-LOGICAL-c500t-9c4d5a61f296b43ebd3b9cd8c7eb27048309a404491b7ac1d1bd92c2184d4fa03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17093030$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16156461$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Panousis, Konstantinos</creatorcontrib><creatorcontrib>Grigoris, Peter</creatorcontrib><creatorcontrib>Butcher, Ian</creatorcontrib><creatorcontrib>Rana, Bardeep</creatorcontrib><creatorcontrib>Reilly, James H</creatorcontrib><creatorcontrib>Hamblen, David L</creatorcontrib><title>Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92 cases</title><title>Acta orthopaedica</title><addtitle>Acta Orthop</addtitle><description>Background The diagnosis of prosthetic infection remains a challenge, as no test is 100% sensitive and 100% specific Recent advances in molecular biology have enabled the detection of infection in culture negative cases.
Patients and methods We evaluated the effectiveness of polymerase chain reaction (PCR) in detecting infection in failed joint replacements prospectively in 91 consecutive patients (92 prosthetic joints) undergoing revision total hip or knee arthroplasty. Synovial fluid was collected intraoperatively and examined by broad-range PCR assay for detection of bacterial DNA. The clinical diagnosis of infection was based on the results of blood tests, preoperative joint aspiration, culture and histology of multiple intraoperative tissue samples, as well as the surgeon's assessment.
12 joints (13%) were infected, but the PCR was positive in 32 cases. The sensitivity of the technique was 92%, the specificity 74%, the accuracy 76%, the positive predictive value 34%, and the negative predictive value was 98%.
Interpretation The PCR technique cannot be recommended for the routine detection of prosthetic infection. The large number of false positive results may represent sample contamination, or bacterial presence related to low-virulence organisms, low bacterial load, or a strong host immune response.</description><subject>Arthroplasty, Replacement, Hip - adverse effects</subject><subject>Arthroplasty, Replacement, Knee - adverse effects</subject><subject>Bacterial Infections - diagnosis</subject><subject>Bacterial Infections - microbiology</subject><subject>Biological and medical sciences</subject><subject>Diseases of the osteoarticular system</subject><subject>DNA, Bacterial - analysis</subject><subject>False Positive Reactions</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Miscellaneous. Osteoarticular involvement in other diseases</subject><subject>Orthopedic surgery</subject><subject>Polymerase Chain Reaction - standards</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Prosthesis Failure</subject><subject>Prosthesis-Related Infections - diagnosis</subject><subject>Prosthesis-Related Infections - microbiology</subject><subject>Reoperation</subject><subject>Sensitivity and Specificity</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Synovial Fluid - microbiology</subject><issn>1745-3674</issn><issn>1745-3682</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE2L1TAUhoMozof-ADeSje6qJ03aNOhGLo4KAw6i63qanHo75DbXJB25_94MtzqIMKsccp73JXkYeybglYAOXgOAaJWGRgDIctE8YKdCq6aSbVc__DtrdcLOUrouUKcMPGYnohVNq1pxyr5fhRD5PpKbbJ5uiN-gX4iHkQ8xoKsizj-IX22-8LFweUvcUaaChvkWwpi3Mew9pnzg0zyum2nmpuYWE6Un7NGIPtHT9Txn3y7ef918rC4_f_i0eXdZ2QYgV8Yq12Arxtq0g5I0ODkY6zqraag1qE6CQQVKGTFotMKJwZna1qJTTo0I8py9PPbuY_i5UMr9bkqWvMeZwpL6tmu0ViALKI6gjSGlSGO_j9MO46EX0N9q7f_TWjLP1_Jl2JG7S6weC_BiBTBZ9GPRZqd0x2kwsnQV7u2RK65C3OGvEL3rMx58iH9C8r53vPknviX0eWsxUn8dljgXwff84jes5qP0</recordid><startdate>20050601</startdate><enddate>20050601</enddate><creator>Panousis, Konstantinos</creator><creator>Grigoris, Peter</creator><creator>Butcher, Ian</creator><creator>Rana, Bardeep</creator><creator>Reilly, James H</creator><creator>Hamblen, David L</creator><general>Informa UK Ltd</general><general>Taylor & Francis</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20050601</creationdate><title>Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92 cases</title><author>Panousis, Konstantinos ; Grigoris, Peter ; Butcher, Ian ; Rana, Bardeep ; Reilly, James H ; Hamblen, David L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c500t-9c4d5a61f296b43ebd3b9cd8c7eb27048309a404491b7ac1d1bd92c2184d4fa03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Arthroplasty, Replacement, Hip - adverse effects</topic><topic>Arthroplasty, Replacement, Knee - adverse effects</topic><topic>Bacterial Infections - diagnosis</topic><topic>Bacterial Infections - microbiology</topic><topic>Biological and medical sciences</topic><topic>Diseases of the osteoarticular system</topic><topic>DNA, Bacterial - analysis</topic><topic>False Positive Reactions</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Miscellaneous. Osteoarticular involvement in other diseases</topic><topic>Orthopedic surgery</topic><topic>Polymerase Chain Reaction - standards</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Prosthesis Failure</topic><topic>Prosthesis-Related Infections - diagnosis</topic><topic>Prosthesis-Related Infections - microbiology</topic><topic>Reoperation</topic><topic>Sensitivity and Specificity</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Synovial Fluid - microbiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Panousis, Konstantinos</creatorcontrib><creatorcontrib>Grigoris, Peter</creatorcontrib><creatorcontrib>Butcher, Ian</creatorcontrib><creatorcontrib>Rana, Bardeep</creatorcontrib><creatorcontrib>Reilly, James H</creatorcontrib><creatorcontrib>Hamblen, David L</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Acta orthopaedica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Panousis, Konstantinos</au><au>Grigoris, Peter</au><au>Butcher, Ian</au><au>Rana, Bardeep</au><au>Reilly, James H</au><au>Hamblen, David L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92 cases</atitle><jtitle>Acta orthopaedica</jtitle><addtitle>Acta Orthop</addtitle><date>2005-06-01</date><risdate>2005</risdate><volume>76</volume><issue>3</issue><spage>341</spage><epage>346</epage><pages>341-346</pages><issn>1745-3674</issn><eissn>1745-3682</eissn><abstract>Background The diagnosis of prosthetic infection remains a challenge, as no test is 100% sensitive and 100% specific Recent advances in molecular biology have enabled the detection of infection in culture negative cases.
Patients and methods We evaluated the effectiveness of polymerase chain reaction (PCR) in detecting infection in failed joint replacements prospectively in 91 consecutive patients (92 prosthetic joints) undergoing revision total hip or knee arthroplasty. Synovial fluid was collected intraoperatively and examined by broad-range PCR assay for detection of bacterial DNA. The clinical diagnosis of infection was based on the results of blood tests, preoperative joint aspiration, culture and histology of multiple intraoperative tissue samples, as well as the surgeon's assessment.
12 joints (13%) were infected, but the PCR was positive in 32 cases. The sensitivity of the technique was 92%, the specificity 74%, the accuracy 76%, the positive predictive value 34%, and the negative predictive value was 98%.
Interpretation The PCR technique cannot be recommended for the routine detection of prosthetic infection. The large number of false positive results may represent sample contamination, or bacterial presence related to low-virulence organisms, low bacterial load, or a strong host immune response.</abstract><cop>Basingstoke</cop><pub>Informa UK Ltd</pub><pmid>16156461</pmid><doi>10.1080/00016470510030805</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Arthroplasty, Replacement, Hip - adverse effects Arthroplasty, Replacement, Knee - adverse effects Bacterial Infections - diagnosis Bacterial Infections - microbiology Biological and medical sciences Diseases of the osteoarticular system DNA, Bacterial - analysis False Positive Reactions Humans Medical sciences Miscellaneous. Osteoarticular involvement in other diseases Orthopedic surgery Polymerase Chain Reaction - standards Predictive Value of Tests Prospective Studies Prosthesis Failure Prosthesis-Related Infections - diagnosis Prosthesis-Related Infections - microbiology Reoperation Sensitivity and Specificity Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Synovial Fluid - microbiology |
| title | Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92 cases |
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