title: Culture and PCR analysis of joint fluid in the diagnosis of prosthetic joint infection.
abstract: This prospective study compared PCR and culture techniques in the diagnosis of prosthetic joint infection (PJI). We obtained joint fluid samples (JFS; n=115) from patients who had failed total joint arthroplasty between January 2003 and June 2005; 49 were positive for PJI according to established strict criteria. JFS were analyzed by PCR (n=35; control n=66) or culture (n=46, control n=48). PCR was positive in 71% of PJI cases, resulting in sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and likelihood ratio for positive results as follows: 0.71; 0.97; 0.88; 0.93; 0.87 and 23.6, respectively. Culture was positive in 44% of PJI samples. Corresponding statistics were 0.44; 0.94; 0.69; 0.87; 0.63 and 7.0, respectively. Significantly higher sensitivity, accuracy and negative predictive values were calculated for PCR versus culture, and there was 83% concordance between the results of intraoperative culture and PCR detection of causative bacteria. Therefore, we conclude that PCR analysis of synovial fluid increases the utility of pre-operative aspiration for patients who require revision total joint surgery.
authors.affiliation: Department of Orthopaedics, University Hospital and Faculty of Medicine and Dentistry, Palacký University, I.P. Pavlova 6, Olomouc, Czech Republic. jiri.gallo@volny.cz
authors.forename: Jiri
authors.initials: J
authors.lastname: Gallo
authors.forename: Milan
authors.initials: M
authors.lastname: Kolar
authors.forename: Milos
authors.initials: M
authors.lastname: Dendis
authors.forename: Yvona
authors.initials: Y
authors.lastname: Loveckova
authors.forename: Pavel
authors.initials: P
authors.lastname: Sauer
authors.forename: Jana
authors.initials: J
authors.lastname: Zapletalova
authors.forename: Dagmar
authors.initials: D
authors.lastname: Koukalova
mesh_terms: D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D001424:Bacterial Infections / Q000175:diagnosis / Q000382:microbiology; D001431:Bacteriological Techniques; D003470:Culture Media; D004269:DNA, Bacterial / Q000032:analysis; D006090:Gram-Negative Bacteria / Q000235:genetics / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D016133:Polymerase Chain Reaction / Q000379:methods*; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000382:microbiology*; D012680:Sensitivity and Specificity; D013582:Synovial Fluid / Q000382:microbiology*
chemical_list: D003470:Culture Media; D004269:DNA, Bacterial