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Palmer MP, Melton-Kreft R, Nistico L, Hiller NL, Kim LHJ, Altman GT, Altman DT, Sotereanos NG, Hu FZ, De Meo PJ, Ehrlich GD. Polymerase Chain Reaction-Electrospray-Time-of-Flight Mass Spectrometry Versus Culture for Bacterial Detection in Septic Arthritis and Osteoarthritis. Genet Test Mol Biomarkers 2016; 20:721-731. [PMID: 27749085 PMCID: PMC5180073 DOI: 10.1089/gtmb.2016.0080] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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.
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Affiliation(s)
- Michael P Palmer
- 1 88th Surgical Operations Squadron, Orthopedic Surgery , Wright-Patterson Airforce Base, Dayton, Ohio
| | - Rachael Melton-Kreft
- 2 Center of Excellence in Biofilm Research , Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Laura Nistico
- 2 Center of Excellence in Biofilm Research , Allegheny Health Network, Pittsburgh, Pennsylvania
| | - N Louisa Hiller
- 3 Department of Biological Sciences, Carnegie Mellon University , Pittsburgh, Pennsylvania
| | - Leon H J Kim
- 3 Department of Biological Sciences, Carnegie Mellon University , Pittsburgh, Pennsylvania
| | - Gregory T Altman
- 4 Department of Orthopaedic Surgery, Allegheny General Hospital , Pittsburgh, Pennsylvania
| | - Daniel T Altman
- 4 Department of Orthopaedic Surgery, Allegheny General Hospital , Pittsburgh, Pennsylvania
| | - Nicholas G Sotereanos
- 4 Department of Orthopaedic Surgery, Allegheny General Hospital , Pittsburgh, Pennsylvania
| | - Fen Z Hu
- 5 Institute for Molecular Medicine and Infectious Disease, Center for Genomic Sciences, Drexel University College of Medicine , Philadelphia, Pennsylvania
| | - Patrick J De Meo
- 4 Department of Orthopaedic Surgery, Allegheny General Hospital , Pittsburgh, Pennsylvania
| | - Garth D Ehrlich
- 5 Institute for Molecular Medicine and Infectious Disease, Center for Genomic Sciences, Drexel University College of Medicine , Philadelphia, Pennsylvania.,6 Institute for Molecular Medicine and Infectious Disease, Center for Advanced Microbial Processing, Drexel University College of Medicine , Philadelphia, Pennsylvania.,7 Department of Microbiology and Immunology, Drexel University College of Medicine , Philadelphia, Pennsylvania.,8 Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine , Philadelphia, Pennsylvania
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Wasko MK, Goodman SB. Emperor's new clothes: Is particle disease really infected particle disease? J Orthop Res 2016; 34:1497-504. [PMID: 27175824 PMCID: PMC5529039 DOI: 10.1002/jor.23292] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 05/10/2016] [Indexed: 02/04/2023]
Abstract
Aseptic loosening remains the most significant long-term complication of total hip replacement. The current paradigm points to an inflammatory response to wear particles as its main trigger. Recently, there have been increasing numbers of positive bacterial isolates reported among patients with clinically absent infection. This paper reviews existing evidence on possible involvement of bacteria and microbial-associated molecular patterns in the pathology of so-called "aseptic loosening." © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1497-1504, 2016.
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Affiliation(s)
- Marcin K. Wasko
- Department of Orthopaedic and Rheumoorthopaedic Surgery, The Medical Centre of Postgraduate Education, Warsaw, Poland,Foundation for the Development of Medicine, Slupsk, Poland,SPSK im. Prof. A. Grucy, Konarskiego 13, Otwock 05-400, Poland
| | - Stuart B. Goodman
- Department of Orthopaedic Surgery, Orthopaedic Surgery Laboratories, Stanford University, Stanford, California,Department of Bioengineering, Stanford University, Stanford, California
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McLean JS, Lasken RS. Single cell genomics of bacterial pathogens: outlook for infectious disease research. Genome Med 2014; 6:108. [PMID: 25621014 PMCID: PMC4304388 DOI: 10.1186/s13073-014-0108-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Genomic sequencing from single cells is a powerful tool in microbiology and holds great promise for infectious disease research. Vast numbers of uncultivable species and pathogens that persist at low abundance in environmental reservoirs are now accessible for genomic analysis.
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Affiliation(s)
- Jeffrey S McLean
- School of Dentistry, Department of Periodontics, University of Washington, Seattle, WA 98195 USA ; J. Craig Venter Institute, Capricorn Lane, La Jolla, CA 92037 USA
| | - Roger S Lasken
- J. Craig Venter Institute, Capricorn Lane, La Jolla, CA 92037 USA
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