Journal article
Polymerase Chain Reaction–Electrospray–Time-of-Flight Mass Spectrometry Versus Culture for Bacterial Detection in Septic Arthritis and Osteoarthritis
Genetic testing and molecular biomarkers, Vol.20(12), pp.721-731
01 Dec 2016
PMCID: PMC5180073
PMID: 27749085
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background:
Preliminary studies have identified known bacterial pathogens in the knees of patients with osteoarthritis (OA) before arthroplasty.
Aims:
The current study was designed to determine the incidence and types of bacteria present in the synovial fluid of native knee joints from adult patients with diagnoses of septic arthritis and OA.
Patients and Methods:
Patients were enrolled between October 2010 and January 2013. Synovial fluid samples from the affected knee were collected and evaluated with both traditional microbial culture and polymerase chain reaction–electrospray ionization–time-of-flight mass spectrometry (molecular diagnostics [MDx]) to prospectively characterize the microbial content. Patients were grouped by diagnosis into one of two cohorts, those with clinical suspicion of septic arthritis (
n
= 44) and those undergoing primary arthroplasty of the knee for OA (
n
= 21). In all cases where discrepant culture and MDx results were obtained, we performed species-specific 16S rRNA fluorescence
in situ
hybridization (FISH) as a confirmatory test.
Results:
MDx testing identified bacteria in 50% of the suspected septic arthritis cases and 29% of the arthroplasty cases, whereas culture detected bacteria in only 16% of the former and 0% of the latter group. The overall difference in detection rates for culture and MDx was very highly significant,
p
-value = 2.384 × 10
−7
. All of the culture-positive cases were typed as
Staphylococcus aureus
. Two of the septic arthritis cases were polymicrobial as was one of the OA cases by MDx. FISH testing of the specimens with discordant results supported the MDx findings in 91% (19/21) of the cases, including one case where culture detected
S. aureus
and MDx detected
Streptococcus agalactiae.
Conclusions:
MDx were more sensitive than culture, as confirmed by FISH. FISH only identifies bacteria that are embedded or infiltrated within the tissue and is thus not susceptible to contamination. Not all suspected cases of septic arthritis contain bacteria, but a significant percent of patients with OA, and no signs of infection, have FISH-confirmed bacterial biofilms present in the knee.
Metrics
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Details
- Title
- Polymerase Chain Reaction–Electrospray–Time-of-Flight Mass Spectrometry Versus Culture for Bacterial Detection in Septic Arthritis and Osteoarthritis
- Creators
- Michael P Palmer - 188th Surgical Operations Squadron, Orthopedic Surgery, Wright-Patterson Airforce Base, Dayton, OhioRachael Melton-Kreft - 2Center of Excellence in Biofilm Research, Allegheny Health Network, Pittsburgh, PennsylvaniaLaura Nistico - 2Center of Excellence in Biofilm Research, Allegheny Health Network, Pittsburgh, PennsylvaniaN. Louisa Hiller - 3Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, PennsylvaniaLeon H.J Kim - 3Department of Biological Sciences, Carnegie Mellon University, Pittsburgh, PennsylvaniaGregory T Altman - 4Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PennsylvaniaDaniel T Altman - 4Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PennsylvaniaNicholas G Sotereanos - 4Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PennsylvaniaFen Z Hu - 5Institute for Molecular Medicine and Infectious Disease, Center for Genomic Sciences, Drexel University College of Medicine, Philadelphia, PennsylvaniaPatrick J De Meo - 4Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PennsylvaniaGarth D Ehrlich - 8Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Publication Details
- Genetic testing and molecular biomarkers, Vol.20(12), pp.721-731
- Publisher
- Mary Ann Liebert, Inc
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Orthopedic/Orthopaedic Surgery; Microbiology and Immunology
- Identifiers
- 991014969777604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Biochemistry & Molecular Biology
- Genetics & Heredity