title: MALDI-TOF MS performance compared to direct examination, culture, and 16S rDNA PCR for the rapid diagnosis of bone and joint infections.
abstract: The rapid identification of bacterial species involved in bone and joint infections (BJI) is an important element to optimize the diagnosis and care of patients. The aim of this study was to evaluate the usefulness of matrix-assisted laser desorption ionization mass spectrometry (MALDI-TOF MS) for the rapid diagnosis of bone infections, directly on synovial fluid (SF) or on crushed osteoarticular samples (CS). From January to October 2013, we prospectively analyzed 111 osteoarticular samples (bone and joint samples, BJS) from 78 patients in care at the University Hospital of Rennes, France. The diagnosis procedure leading to the sample collection was linked to a suspicion of infection, inflammatory disease, arthritis, or for any bone or joint abnormalities. Standard bacteriological diagnosis and molecular biology analysis [16S rRNA polymerase chain reaction (PCR) and sequencing] were conducted. In addition, analysis by MALDI-TOF MS was performed directly on the osteoarticular samples, as soon as the amount allowed. Culture, which remains the gold standard for the diagnosis of BJI, has the highest sensitivity (85.9 %) and remains necessary to test antimicrobial susceptibility. The 16S rDNA PCR results were positive in the group with positive BJI (28.6 %) and negative in the group without infection. Direct examination remains insensitive (31.7 %) but more effective than MALDI-TOF MS directly on the sample (6.3 %). The specificity was 100 % in all cases, except for culture (74.5 %). Bacterial culture remains the gold standard, especially enrichment in blood bottles. Direct analysis of bone samples with MALDI-TOF MS is not useful, possibly due to the low inoculum of BJS.
authors.affiliation: Pole Biologie, Rennes University Hospital, rue Henri Le Guilloux, 35043, Rennes, France.
authors.forename: E
authors.initials: E
authors.lastname: Lallemand
authors.affiliation: INSERM UMR U991, Rennes, France.|Centres de Référence pour les Infections Ostéo-articulaires Complexes du Grand Ouest (CRIOGO), Rennes, France.|Service de Rhumatologie, Rennes University Hospital, rue Henri Le Guilloux, 35043, Rennes, France.
authors.forename: G
authors.initials: G
authors.lastname: Coiffier
authors.affiliation: Centres de Référence pour les Infections Ostéo-articulaires Complexes du Grand Ouest (CRIOGO), Rennes, France.|Service de Maladies Infectieuses, Rennes University Hospital, rue Henri Le Guilloux, 35043, Rennes, France.
authors.forename: C
authors.initials: C
authors.lastname: Arvieux
authors.affiliation: Centres de Référence pour les Infections Ostéo-articulaires Complexes du Grand Ouest (CRIOGO), Rennes, France.|Imagerie Ostéo-articulaire, Rennes University Hospital, rue Henri Le Guilloux, 35043, Rennes, France.
authors.forename: E
authors.initials: E
authors.lastname: Brillet
authors.affiliation: INSERM UMR U991, Rennes, France.|Centres de Référence pour les Infections Ostéo-articulaires Complexes du Grand Ouest (CRIOGO), Rennes, France.|Service de Rhumatologie, Rennes University Hospital, rue Henri Le Guilloux, 35043, Rennes, France.|Université de Rennes 1, 35043, Rennes, France.
authors.forename: P
authors.initials: P
authors.lastname: Guggenbuhl
authors.affiliation: Pole Biologie, Rennes University Hospital, rue Henri Le Guilloux, 35043, Rennes, France. anne.gougeon@univ-rennes1.fr.|INSERM UMR U991, Rennes, France. anne.gougeon@univ-rennes1.fr.|Université de Rennes 1, 35043, Rennes, France. anne.gougeon@univ-rennes1.fr.|Equipe de Microbiologie, EA 1254, Université de Rennes 1, 2, avenue du Professeur Léon Bernard, 35043, Rennes, France. anne.gougeon@univ-rennes1.fr.
authors.forename: A
authors.initials: A
authors.lastname: Jolivet-Gougeon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000382:microbiology*; D001419:Bacteria / Q000145:classification* / Q000235:genetics*; D001850:Bone Diseases, Infectious / Q000175:diagnosis* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D012336:RNA, Ribosomal, 16S / Q000235:genetics*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization / Q000379:methods
chemical_list: D012336:RNA, Ribosomal, 16S