title: Evaluation of 16S rRNA gene PCR sensitivity and specificity for diagnosis of prosthetic joint infection: a prospective multicenter cross-sectional study.
abstract: There is no standard method for the diagnosis of prosthetic joint infection (PJI). The contribution of 16S rRNA gene PCR sequencing on a routine basis remains to be defined. We performed a prospective multicenter study to assess the contributions of 16S rRNA gene assays in PJI diagnosis. Over a 2-year period, all patients suspected to have PJIs and a few uninfected patients undergoing primary arthroplasty (control group) were included. Five perioperative samples per patient were collected for culture and 16S rRNA gene PCR sequencing and one for histological examination. Three multicenter quality control assays were performed with both DNA extracts and crushed samples. The diagnosis of PJI was based on clinical, bacteriological, and histological criteria, according to Infectious Diseases Society of America guidelines. A molecular diagnosis was modeled on the bacteriological criterion (≥ 1 positive sample for strict pathogens and ≥ 2 for commensal skin flora). Molecular data were analyzed according to the diagnosis of PJI. Between December 2010 and March 2012, 264 suspected cases of PJI and 35 control cases were included. PJI was confirmed in 215/264 suspected cases, 192 (89%) with a bacteriological criterion. The PJIs were monomicrobial (163 cases [85%]; staphylococci, n = 108; streptococci, n = 22; Gram-negative bacilli, n = 16; anaerobes, n = 13; others, n = 4) or polymicrobial (29 cases [15%]). The molecular diagnosis was positive in 151/215 confirmed cases of PJI (143 cases with bacteriological PJI documentation and 8 treated cases without bacteriological documentation) and in 2/49 cases without confirmed PJI (sensitivity, 73.3%; specificity, 95.5%). The 16S rRNA gene PCR assay showed a lack of sensitivity in the diagnosis of PJI on a multicenter routine basis.
authors: CHU Nantes, Laboratoire de Bactériologie, Nantes, France pascale.bemer@chu-nantes.fr.
authors: Pascale
authors: P
authors: Bémer
authors: CHU Poitiers, Laboratoire de Bactériologie, Poitiers, France.
authors: Chloé
authors: C
authors: Plouzeau
authors: CHU Brest, Laboratoire de Bactériologie, Brest, France.
authors: Didier
authors: D
authors: Tande
authors: INSERM, CIC 1415, Tours, France.
authors: Julie
authors: J
authors: Léger
authors: INSERM, CIC 1415, Tours, France.
authors: Bruno
authors: B
authors: Giraudeau
authors: CHU Tours, Laboratoire de Bactériologie, Tours, France.
authors: Anne Sophie
authors: AS
authors: Valentin
authors: CHU Rennes, Laboratoire de Bactériologie, Rennes, France.
authors: Anne
authors: A
authors: Jolivet-Gougeon
authors: CHU Rennes, Laboratoire de Bactériologie, Rennes, France.
authors: Pascal
authors: P
authors: Vincent
authors: CHU Nantes, Laboratoire de Bactériologie, Nantes, France.
authors: Stéphane
authors: S
authors: Corvec
authors: CHU Nantes, Laboratoire de Bactériologie, Nantes, France.
authors: Sophie
authors: S
authors: Gibaud
authors: CHU Nantes, Laboratoire de Bactériologie, Nantes, France.
authors: Marie Emmanuelle
authors: ME
authors: Juvin
authors: CHU Brest, Laboratoire de Bactériologie, Brest, France.
authors: Genevieve
authors: G
authors: Héry-Arnaud
authors: CHU Angers, Angers, France.
authors: Carole
authors: C
authors: Lemarié
authors: CHU Angers, Angers, France.
authors: Marie
authors: M
authors: Kempf
authors: CHU Orléans, Laboratoire de Bactériologie, Orléans, France.
authors: Laurent
authors: L
authors: Bret
authors: CHU Tours, Laboratoire de Bactériologie, Tours, France.
authors: Roland
authors: R
authors: Quentin
authors: INSERM, CIC 1415, Tours, France.
authors: Carine
authors: C
authors: Coffre
authors: CHU Tours, Laboratoire d'Anatomo-Pathologie, Tours, France.
authors: Gonzague
authors: G
authors: de Pinieux
authors: CHU Tours, Service des Maladies Infectieuses, Tours, France.
authors: Louis
authors: L
authors: Bernard
authors: CHU Poitiers, Laboratoire de Bactériologie, Poitiers, France.
authors: Christophe
authors: C
authors: Burucoa
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis*; D004269:DNA, Bacterial / Q000235:genetics; D004275:DNA, Ribosomal / Q000235:genetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D010003:Osteoarthritis / Q000175:diagnosis*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis*; D012336:RNA, Ribosomal, 16S / Q000235:genetics*; D012680:Sensitivity and Specificity
chemical_list: D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S