Multicentre prospective evaluation of histological and molecular criterion for diagnosis of prosthetic-joint infection

TitreMulticentre prospective evaluation of histological and molecular criterion for diagnosis of prosthetic-joint infection
Type de publicationCommunication
TypeCommunication par affiche dans un congrès
Année2013
LangueAnglais
Date du colloque27-30/04/2013
Titre du colloque23rd European Congress of Clinical Microbiology and Infectious Diseases
AuteurBémer, Pascale, Tande, Didier, Plouzeau, Chloé, Léger, Julie, Valentin, Anne Sophie, Gougeon, A., Vincent, Pascal, Corvec, Stéphane, Juvin, Marie Emmanuelle, Héry-Arnaud, Genevieve, Lemarié, Carole, Kempf, Marie , Bret, Laurent, Quentin, Roland, de Pinieux, Gonzague, Bernard, Louis, Burucoa, Christophe
OrganismeCRIOGO (Centre de Référence des Infections Ostéo-articulaires du Grand Ouest) Study Group
PaysAllemagne
VilleBerlin
Résumé en anglais

Objectives:

This multicenter prospective study was performed to assess the contribution of broad range PCR diagnosis in prosthetic-joint infection (PJI).

Methods:

Adult patients treated for PJI at 7 centers were included between December 2010 and March 2012. Six per-operative samples were obtained for each patient, 5 for conventional cultures and 16S rRNA gene real-time PCR followed by sequencing, and 1 for histopathological classification according to Morawietz. Cultures and PCR were performed in a highly standardized manner, with 3 quality controls of PCR analyses. An infection was considered as proved (3 criteria: per-operative, bacteriological and histological), probable (clinical or bacteriological criterium), or excluded (no criterium). Molecular criterium for predicting PJI was determined using the bacteriological one as reference (>=1 positive sample for virulent organism, and >=3 positive samples for coagulase-negative staphylococci (CoNS) and P. acnes).

Results:

299 patients were included, 264 with suspicion of sepsis (S) and 35 as controls (C). The 264 S presented with acute (19%), or chronic suspicion of PJI (81%). Infection was proved or probable in 212/264 S (80%), with the bacteriological criterium in 189/212 S (89%). Out of these, 156 (83%) had monomicrobial and 33 (17%) polymicrobial infections. The isolated pathogens were S. aureus (40%), CoNS (25%), streptococci (14%), Gram-Negative rods (10%), and anaerobes 8%.
Histology results were not available for 55 patients, leaving 244 patients available for analysis. Histological findings of infection (Morawietz types II or III) were present in 128/169 (76%) proved or probable infections, in 3 patients without any other criterium, and were absent in excluded infections (n=42) and controls (n=29). PCR results were not analysable for 32 patients (S=28, C=4), leaving 267 patients (S=236, C=31) available for analysis. Molecular criterium of infection was present in 63/68 (93%) proved infections, 83/124 (67%) probable infections, 3/42 excluded infections, 0/2 histological criterium alone and 2/31 controls. Molecular criterium of infection was absent in 34/189 (18%) culture-positive S, and present in 8/23 culture-negative S (8 patients treated with antibiotics).

Conclusions:

According to this multicenter prospective study, 16S rRNA gene real-time PCR is less susceptible than culture for diagnosis of PJI. Molecular analysis could be recommended in culture-negative patients who were receiving antibiotics.

URL de la noticehttp://okina.univ-angers.fr/publications/ua11345