Study: Polymerase chain reaction for PJI diagnosis is not useful as standalone test
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Multiplex polymerase chain reaction, which uses polymerase chain reaction to simultaneously amplify several different next-generation DNA sequences, had 25.6% sensitivity when performed using Musculoskeletal Infection Society criteria for aspirate or tissue samples collected during 93 revision primary total joint arthroplasties and 77 primary total joint arthroplasties, according to study results.
Beau J. Kildow, MD, Alexander L. Lazarides, MD, and colleagues collected the samples for diagnostic workup for prosthetic joint infection (PJI) in the laboratory via polymerase chain reaction (PCR) multiplex testing and other diagnostic studies. Researchers calculated concordances, as well as statistical differences, between the diagnostic studies with a Chi-squared test for categorical data, according to the abstract of the study that was scheduled for presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Compared with the Musculoskeletal Infection Society (MSIS) criteria, Kildow and colleagues found a significantly lower concordance for PCR at 65.9% compared to 87.6% for culture.
“Of the 78 patients that met MSIS criteria, only 20 (25.6%) samples identified an organism,” the researchers wrote in their abstract, noting the difference based on prior infection or sample collection method, such as tissue swab or synovial fluid, was not significant.
“[PJI] continues to be a major challenge. Novel tests continue to be developed to assist in our diagnostic accuracy, but high-level evidence as to their utility is lacking. In our series, [next-generation sequencing] NGS did not provide superior sensitivity or specificity results compared to culture,” Lazarides told Healio Orthopedics. “PCR has little utility as a standalone test for PJI diagnosis with a sensitivity of only 23%. Currently, several laboratory tests used for either criteria for PJI diagnosis should be obtained along with the overall clinical picture to help guide decision-making for PJI treatment.”
Kildow told Healio Orthopedics, “Identifying organisms and their sensitivities continues to remain difficult as we rely upon culture. Exploring molecular technology to help improve the diagnostic accuracy theoretically appears promising. However, in its current state, it cannot be relied upon as clinical data show that is no better than culture. With the advancement of molecular and/or nano technology, we are hoping this completely replaces culture in the future.”
Lazarides added, “Currently, PCR next-generation sequencing is utilized for culture-negative infections to help guide treatment.” – by Susan M. Rapp
References:
Kildow BJ, et al. ePaper 063. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Parvizi J, et al. J Arthroplasty. 2018;doi:10.1016/j.arth.2018.02.078.
Disclosures: Kildow and Lazarides report no relevant financial disclosures.