Karan Goswami, MD

Pathogen identification remains a challenge and culture methods have limitations. Novel molecular methods have become clinically available. Matrix-assisted laser desorption ionization-time of flight mass spectrometry — MALDI-TOF — is a new technology for rapid and cost-effective identification of microorganisms, including those implicated in periprosthetic joint infection. Current methods for identification of pathogens rely upon costly and time-consuming culture techniques. MALDI-TOF exploits the proteome of microorganisms for pathogen recognition. It is efficient for implementation at the large institution-level and can precisely classify microorganisms down to the strain.

Management of periprosthetic joint infection is challenging on many accounts. Fungal periprosthetic joint infections are particularly difficult to treat. The problem is the incidence of fungal infections has increased globally in the last few decades. Fungal periprosthetic infections, although rare, are similarly increasing in prevalence. Most case series of patients with fungal periprosthetic joint infections report a disastrous outcome for surgical management of these patients with treatment failure rates of up to 50% at 2-year follow-up. Part of the problem relates to the complex biofilm that fungi can form. Furthermore, patients with fungal periprosthetic joint infection are often immunocompromised with impaired cellular immunity.