JBJI Journal of Bone and Joint Infection JBJI J. Bone Joint Infect. 2206-3552 Ivyspring Göttingen, Germany 10.7150/jbji.22062 Are There Benefits In Early Diagnosis Of Prosthetic Joint Infection With Multiplex Polymerase Chain Reaction? Lausmann Christian 1 Zahar Akos 1 Citak Mustafa 1 Brañes Julian 2 Schmidl Stefan 1 Frommelt Lars 1 Gehrke Thorsten 1 Gebauer Matthias 1 Helios ENDO-Klinik Hamburg, Department of Orthopedic Surgery, Hamburg, Germany; Hospital San José, University of Santiago de Chile, Santiago, Chile. 28 09 2017 2 4 175 183 Copyright: © 2017 Christian Lausmann et al. 2017 This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/ This article is available from https://jbji.copernicus.org/articles/2/175/2017/jbji-2-175-2017.html The full text article is available as a PDF file from https://jbji.copernicus.org/articles/2/175/2017/jbji-2-175-2017.pdf

<p class="p p-first" id="__p2"><em>Purpose</em> Identification of bacteria and susceptibility are fundamental in periprosthetic joint infection (PJI). Especially in the case of systemic inflammatory response syndrome (SIRS) rapid detection of pathogens is essential for proper therapy. Bacterial cultures are time consuming. The polymerase chain reaction (PCR) is a non-culture molecular method and is able to rapidly identify pathogens and their resistance genes. Multiplex PCR (mPCR) can amplify several different DNA sequences simultaneously. The aim of this study was to show the value of mPCR for early diagnosis of PJI.</p><p id="__p3"><em>Methods</em> 60 patients undergoing total hip or knee revisions were recruited in this prospective single-centre-study. Three groups were created: 26 patients with aseptic loosening (negative control), 26 patients with chronic PJI, and 8 patients with acute PJI/SIRS. We compared the results of joint aspirates obtained intraoperatively investigated by mPCR with the microbiology results of tissue specimens.</p><p id="__p4"><em>Results</em> The overall sensitivity of mPCR was 78.8% (95% CI, 61.1 - 91.0%), the specificity was 100% (95% CI, 87.2 - 100%), the negative predictive value was 79.4% (95% CI, 62.1 - 91.3%), the positive predictive value was 100% (95% CI, 86.8 - 100%), and the overall accuracy was 88.3% (95% CI, 77.4 - 95.2%). The overall accuracy in acute infections/SIRS (87.5%) was greater than in late chronic PJI (76.9%). In PJI the mPCR was able to provide the results within 5 hours whereas the mean time for cultures was 6.4 days.</p><p class="p p-last" id="__p5"><em>Conclusions</em> Multiplex PCR is a reliable diagnostic tool in PJI management, especially in acute cases complicated with SIRS. Early diagnosis within several hours is possible, targeted antibiotic treatment can be started promptly.</p>

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