title: New methods for the detection of orthopedic and other biofilm infections.
abstract: The detection and identification of bacteria present in natural and industrial ecosystems is now entirely based on molecular systems that detect microbial RNA or DNA. Culture methods were abandoned, in the 1980s, because direct observations showed that <1% of the bacteria in these systems grew on laboratory media. Culture methods comprise the backbone of the Food and Drug Administration-approved diagnostic systems used in hospital laboratories, with some molecular methods being approved for the detection of specific pathogens that are difficult to grow in vitro. In several medical specialties, the reaction to negative cultures in cases in which overt signs of infection clearly exist has produced a spreading skepticism concerning the sensitivity and accuracy of traditional culture methods. We summarize evidence from the field of orthopedic surgery, and from other medical specialties, that support the contention that culture techniques are especially insensitive and inaccurate in the detection of chronic biofilm infections. We examine the plethora of molecular techniques that could replace cultures in the diagnosis of bacterial diseases, and we identify the new Ibis technique that is based on base ratios (not base sequences), as the molecular system most likely to fulfill the requirements of routine diagnosis in orthopedic surgery.
authors.affiliation: Center for Genomic Sciences, Allegheny-Singer Research Institute, Pittsburgh, PA, USA. wcostert@wpahs.org
authors.forename: John William
authors.initials: JW
authors.lastname: Costerton
authors.forename: James Christopher
authors.initials: JC
authors.lastname: Post
authors.forename: Garth D
authors.initials: GD
authors.lastname: Ehrlich
authors.forename: Fen Z
authors.initials: FZ
authors.lastname: Hu
authors.forename: Rachael
authors.initials: R
authors.lastname: Kreft
authors.forename: Laura
authors.initials: L
authors.lastname: Nistico
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kathju
authors.forename: Paul
authors.initials: P
authors.lastname: Stoodley
authors.forename: Luanne
authors.initials: L
authors.lastname: Hall-Stoodley
authors.forename: Gerhard
authors.initials: G
authors.lastname: Maale
authors.forename: Garth
authors.initials: G
authors.lastname: James
authors.forename: Nick
authors.initials: N
authors.lastname: Sotereanos
authors.forename: Patrick
authors.initials: P
authors.lastname: DeMeo
mesh_terms: D001419:Bacteria / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification*; D001431:Bacteriological Techniques / Q000379:methods*; D018441:Biofilms / Q000254:growth & development*; D006801:Humans; D009984:Orthopedic Fixation Devices / Q000382:microbiology*; D012680:Sensitivity and Specificity