Articles | Volume 9, issue 1
https://doi.org/10.5194/jbji-9-87-2024
© Author(s) 2024. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-9-87-2024
© Author(s) 2024. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Original full-length article
| 
28 Feb 2024
Original full-length article |
| 28 Feb 2024
| 28 Feb 2024
Potential value of a rapid syndromic multiplex PCR for the diagnosis of native and prosthetic joint infections: a real-world evidence study
Stéphanie Pascual
CORRESPONDING AUTHOR
bioMérieux, Marcy l'Etoile, France
Brooklyn Noble
bioMérieux, Salt Lake City, USA
Nusreen Ahmad-Saeed
University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Catherine Aldridge
Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
Simone Ambretti
S. Orsola Bologna, Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Sharon Amit
Sheba Medical Center, Ramat Gan, Israel
Rachel Annett
University Hospital of Wales, Cardiff, Wales, United Kingdom
Shaan Ashk O'Shea
University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Anna Maria Barbui
San Giovanni Battista, Department of Public Health and Pediatrics Microbiology and Virology Unit, Città della Salute e della Scienza, Turin, Italy
Gavin Barlow
Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
Lucinda Barrett
Oxford University Hospitals (OUH), Oxford, United Kingdom
Mario Berth
AZ Alma, Eeklo, Belgium
Alessandro Bondi
Department of Public Health and Pediatrics, University of Turin, Turin, Italy
Nicola Boran
Mater Misericordiae University Hospital, Dublin, Ireland
Sara E. Boyd
Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
Catarina Chaves
Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Martin Clauss
University Hospital Basel, Basel, Switzerland
Peter Davies
NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
Ileana T. Dianzo-Delgado
Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
Jaime Esteban
Dept. of Clinical Microbiology, IIS-Fundación Jiménez Díaz, CIBERINFEC-CIBER de Enfermedades Infecciosas, Madrid, Spain
Stefan Fuchs
Institute of Hygiene and Medical Microbiology Medizinische Universität Innsbruck, Innsbruck, Austria
Lennart Friis-Hansen
Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
Dept. Clinical Microbiology at Rigshospitalet, Copenhagen, Denmark
Daniel Goldenberger
University Hospital Basel, Basel, Switzerland
Andrej Kraševac Glaser
NZOLH Maribor, Maribor, Slovenia
Juha O. Groonroos
Varsinais-Suomen sairaanhoitopiiri, Loimaa, Finland
Ines Hoffmann
MVZ Labor Dr. Reising-Ackermann und Kollegen, Limbach Leipzig, Germany
Tomer Hoffmann
Sheba Medical Center, Ramat Gan, Israel
Harriet Hughes
University Hospital of Wales, Cardiff, Wales, United Kingdom
Marina Ivanova
East Tallinn Central Hospital, Tallin, Estonia
Peter Jezek
Regional Hospital Příbram, Příbram, Czech Republic
Gwennan Jones
University Hospital of Wales, Cardiff, Wales, United Kingdom
Zeynep Ceren Karahan
Ankara University School of Medicine Department of Medical Microbiology, Ankara, Türkiye
Cornelia Lass-Flörl
Institute of Hygiene and Medical Microbiology Medizinische Universität Innsbruck, Innsbruck, Austria
Frédéric Laurent
Hospices Civils de Lyon, Lyon, France
Laura Leach
Oxford University Hospitals (OUH), Oxford, United Kingdom
Matilde Lee Horsbøll Pedersen
Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark
Dept. Clinical Microbiology at Rigshospitalet, Copenhagen, Denmark
Caroline Loiez
Centre Hospitalier Universitaire de Lille, Lille, France
Maureen Lynch
Mater Misericordiae University Hospital, Dublin, Ireland
Robert J. Maloney
Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
Martin Marsh
Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
Olivia Milburn
Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
Shanine Mitchell
University Hospital of Wales, Cardiff, Wales, United Kingdom
Luke S. P. Moore
Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
Lynn Moffat
NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
Marianna Murdjeva
University Hospital “St George”, Plovdiv, Bulgaria
Michael E. Murphy
NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
Deepa Nayar
Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
Giacomo Nigrisoli
S. Orsola Bologna, Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Fionnuala O'Sullivan
Mater Misericordiae University Hospital, Dublin, Ireland
Büşra Öz
Ankara University School of Medicine Department of Medical Microbiology, Ankara, Türkiye
Teresa Peach
University Hospital of Wales, Cardiff, Wales, United Kingdom
Christina Petridou
Hampshire Hospitals NHS Foundation Trust, Winchester, UK
Mojgan Prinz
Krankenhaus Göttlicher Heiland, Vienna, Austria
Mitja Rak
Koper lab, Orthopedic Hospital Valdoltra, Valdoltra, Slovenia
Niamh Reidy
Mater Misericordiae University Hospital, Dublin, Ireland
Gian Maria Rossolini
Careggi University Hospital, Florence, Italy
Anne-Laure Roux
Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
Patricia Ruiz-Garbajosa
CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III. Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
Kordo Saeed
University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
Llanos Salar-Vidal
Dept. of Clinical Microbiology, IIS-Fundación Jiménez Díaz, CIBERINFEC-CIBER de Enfermedades Infecciosas, Madrid, Spain
Carlos Salas Venero
Hospital Universitario Marqués de Valdecilla, Santander, Spain
Mathyruban Selvaratnam
Oxford University Hospitals (OUH), Oxford, United Kingdom
Eric Senneville
Centre Hospitalier Universitaire de Lille, Lille, France
Peter Starzengruber
Allgemeines Krankenhaus Wien, Vienna, Austria
Ben Talbot
NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, University of Glasgow, Glasgow, United Kingdom
Vanessa Taylor
University Hospital of Wales, Cardiff, Wales, United Kingdom
Rihard Trebše
Koper lab, Orthopedic Hospital Valdoltra, Valdoltra, Slovenia
Deborah Wearmouth
Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
Birgit Willinger
Allgemeines Krankenhaus Wien, Vienna, Austria
Marjan Wouthuyzen-Bakker
University Medical Center Groningen, Groningen, the Netherlands
Brianne Couturier
bioMérieux, Salt Lake City, USA
Florence Allantaz
bioMérieux, Marcy l'Etoile, France
Editorial note: the article was erroneously published with the co-author Andrej Golle from NZOLH Maribor, Slovenia. In fact, the respective co-author was meant to be Andrej Kraševac Glaser, also affiliated with NZOLH Maribor. This was corrected on 29 May 2024.
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J. Bone Joint Infect., 11, 651–654, https://doi.org/10.5194/jbji-11-651-2026, https://doi.org/10.5194/jbji-11-651-2026, 2026
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Sinus tracts are currently classified as present or absent in PJI definitions. Although appropriate for diagnosis, this binary approach does not reflect the considerable heterogeneity encountered in clinical practice. This Viewpoint highlights characteristics that may determine sinus tract complexity and proposes a framework for future standardized characterization to better inform surgical decision-making and treatment outcomes.
Noémie Reinert, Laura Bessems, Martin Clauss, Nader Maai, Jolien Onsea, Georges Vles, Karl Stoffel, Willem-Jan Metsemakers, and Mario Morgenstern
J. Bone Joint Infect., 11, 635–649, https://doi.org/10.5194/jbji-11-635-2026, https://doi.org/10.5194/jbji-11-635-2026, 2026
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Infected periprosthetic fractures are severe complications in orthopedic surgery with difficult management and high failure rates. This review of 32 studies (273 patients) found limited diagnostic reliability, frequent use of staged revision surgery, and high rates of recurrent infection (21 %) and revision surgeries. Current evidence is sparse and inconsistent, highlighting the need for standardized diagnostics and larger-prospective studies.
Urban Vadnjal, Samo Roškar, René Mihalič, Mitja Rak, and Rihard Trebše
J. Bone Joint Infect., 11, 565–568, https://doi.org/10.5194/jbji-11-565-2026, https://doi.org/10.5194/jbji-11-565-2026, 2026
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The case demonstrates the importance of having well-established hospital algorithms for fracture related infection (FRI)/periprosthetic
joint infection (PJI) treatment and strictly following them at each step. In most severe cases related to multidrug-resistant (MDR) bacteria, a multiple-stage protocol is indicated, and intra-articular infusions of antibiotics should be considered in addition to standard intravenous regimens.
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J. Bone Joint Infect., 11, 489–492, https://doi.org/10.5194/jbji-11-489-2026, https://doi.org/10.5194/jbji-11-489-2026, 2026
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J. Bone Joint Infect., 11, 237–246, https://doi.org/10.5194/jbji-11-237-2026, https://doi.org/10.5194/jbji-11-237-2026, 2026
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Christian Merz, Jan Klaas, Rik Osinga, Parham Sendi, Richard Alexander Kuehl, Mario Morgenstern, and Martin Clauss
J. Bone Joint Infect., 11, 113–121, https://doi.org/10.5194/jbji-11-113-2026, https://doi.org/10.5194/jbji-11-113-2026, 2026
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J. Bone Joint Infect., 10, 581–595, https://doi.org/10.5194/jbji-10-581-2025, https://doi.org/10.5194/jbji-10-581-2025, 2025
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Graham S. Goh, Elise R. Naufal, Michelle M. Dowsey, Sina Babazadeh, Jesse E. Otero, Carlos A. Higuera-Rueda, Marjan Wouthuyzen-Bakker, and Orthopaedic Device Infection Network (ODIN)
J. Bone Joint Infect., 10, 553–559, https://doi.org/10.5194/jbji-10-553-2025, https://doi.org/10.5194/jbji-10-553-2025, 2025
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A multi-center study of 563 periprosthetic joint infections (PJIs) found that 16.5 % were culture negative. These patients more often had prior revision or PJI, longer symptom duration and fewer systemic signs. On multivariable analysis, symptom duration >12 weeks was the only independent risk factor (odds ratio 2.24). The findings support the fact that culture-negative infections present insidiously, informing diagnostic strategies.
Laura Bessems, Jolien Onsea, Baixing Chen, Marjan Wouthuyzen-Bakker, Irene K. Sigmund, Tristan Ferry, Richard Kuehl, Martin Clauss, Alex Soriano, Ricardo Sousa, Annette Schuermans, and Willem-Jan Metsemakers
J. Bone Joint Infect., 10, 489–500, https://doi.org/10.5194/jbji-10-489-2025, https://doi.org/10.5194/jbji-10-489-2025, 2025
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Lukas Rabitsch, Markus Luger, Felix Lötsch, Peter Starzengruber, Florian Thalhammer, Reinhard Windhager, Birgit Willinger, and Irene Katharina Sigmund
J. Bone Joint Infect., 10, 437–446, https://doi.org/10.5194/jbji-10-437-2025, https://doi.org/10.5194/jbji-10-437-2025, 2025
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Hendrika M. Schenk, Marine Sebillotte, Jose Lomas, Adrian Taylor, Eva Benavent, Oscar Murillo, Marta Fernandez-Sampedro, Kaisa Huotari, Craig Aboltins, Rihard Trebse, Alex Soriano, Marjan Wouthuyzen-Bakker, and on behalf of the ESCMID Study Group on Implant Associated Infections (ESGIAI)
J. Bone Joint Infect., 10, 217–224, https://doi.org/10.5194/jbji-10-217-2025, https://doi.org/10.5194/jbji-10-217-2025, 2025
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J. Bone Joint Infect., 10, 165–184, https://doi.org/10.5194/jbji-10-165-2025, https://doi.org/10.5194/jbji-10-165-2025, 2025
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Irene K. Sigmund, Tristan Ferry, Ricardo Sousa, Alex Soriano, Willem-Jan Metsemakers, Martin Clauss, Rihard Trebse, and Marjan Wouthuyzen-Bakker
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Tariq Azamgarhi, Simon Warren, Antonia Scobie, Natasha Karunaharan, Cristina Perez-Sanchez, Rebecca Houghton, Salma Hassan, Julie Lourtet-Hascoët, Hannah Kershaw, Parham Sendi, and Kordo Saeed
J. Bone Joint Infect., 10, 93–100, https://doi.org/10.5194/jbji-10-93-2025, https://doi.org/10.5194/jbji-10-93-2025, 2025
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This study evaluates dalbavancin, an antibiotic with a long duration of action, in treating complex bone and joint infections. It does not require daily dosing, allowing patients to leave the hospital earlier and reducing costs. Dalbavancin is shown to be effective and safe, especially for patients unsuitable for oral antibiotics or outpatient therapy, achieving similar results to traditional treatments while cutting healthcare costs.
Charlotte Smith, Robert J. Maloney, Deborah Wearmouth, Hemant Sharma, Kordo Saeed, Nusreen Ahmad-Saeed, Rachel Annett, Lucinda Barrett, Sara E. Boyd, Peter Davies, Harriet Hughes, Gwennan Jones, Laura Leach, Maureen Lynch, Deepa Nayar, Martin Marsh, Shanine Mitchell, Lynn Moffat, Luke S. P. Moore, Michael E. Murphy, Shaan Ashk O'Shea, Teresa Peach, Christina Petridou, Niamh Reidy, Ben Talbot, Catherine Aldridge, and Gavin Barlow
J. Bone Joint Infect., 10, 61–71, https://doi.org/10.5194/jbji-10-61-2025, https://doi.org/10.5194/jbji-10-61-2025, 2025
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Urgent analysis of joint fluid is a common test in patients with possible septic arthritis (bacterial infection of a joint). One aspect of this test, called the Gram stain, is considered important clinically, but previous single hospital studies have suggested it will miss a considerable number of infections. This large multi-hospital UK study assessed this test and found that it will miss 73 % of infections, questioning its value. More research on rapid tests using new technologies is required.
Sebastian Simon, Marjan Wouthuyzen-Bakker, Susana Gardete Hartmann, Jennyfer A. Mitterer, Sujeesh Sebastian, Stephanie Huber, Bernhard J. H. Frank, and Jochen G. Hofstaetter
J. Bone Joint Infect., 10, 51–59, https://doi.org/10.5194/jbji-10-51-2025, https://doi.org/10.5194/jbji-10-51-2025, 2025
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Seung-Jae Yoon, Paul C. Jutte, Alex Soriano, Ricardo Sousa, Wierd P. Zijlstra, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 9, 231–239, https://doi.org/10.5194/jbji-9-231-2024, https://doi.org/10.5194/jbji-9-231-2024, 2024
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This study validated three models for predicting infection after hip and knee replacement surgery. By analyzing data from 2684 patients in the Netherlands, Portugal, and Spain, we found that the models developed by Tan, Del Toro, and Bülow effectively identified high-risk patients. These models can be used to enhance preoperative counseling and to tailor infection prevention measures individually, potentially improving outcomes and reducing healthcare costs.
Alexandra Wallimann, Yvonne Achermann, Ciara Ferris, Mario Morgenstern, Martin Clauss, Vincent Stadelmann, Hannes Andreas Rüdiger, Liam O'Mahony, and Thomas Fintan Moriarty
J. Bone Joint Infect., 9, 191–196, https://doi.org/10.5194/jbji-9-191-2024, https://doi.org/10.5194/jbji-9-191-2024, 2024
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Skin commensal bacteria such as staphylococci are often the source of orthopaedic-device-related infections. Rifampicin is a widely used antibiotic in the treatment of these infections. The results of this study show that oral rifampicin therapy leads to a consistent and persistent induction of resistance in commensal staphylococci on the skin and in the nose for a prolonged time.
Noémie Reinert, Katinka Wetzel, Fabian Franzeck, Mario Morgenstern, Markus Aschwanden, Thomas Wolff, Martin Clauss, and Parham Sendi
J. Bone Joint Infect., 9, 183–190, https://doi.org/10.5194/jbji-9-183-2024, https://doi.org/10.5194/jbji-9-183-2024, 2024
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We assessed concordance of in-house guidelines for diagnostic principles and antibiotic treatment duration (ABT) 2 years after their implementation. The goal was to standardize diagnostic and treatment principles: are we doing what we recommend? The adherence to recommendations in terms of biopsy sampling was good, moderate for histopathology and poor for anatomic labeling. In terms of ABT duration, the adherence was good, but further shortening for surgically cured cases is necessary.
Céline Dupieux, Ghislaine Descours, Paul Verhoeven, Florence Grattard, Yvonne Benito, François Vandenesch, Céline Cazorla, Tristan Ferry, Sébastien Lustig, Bertrand Boyer, Sandrine Boisset, Anne Carricajo, Frédéric Laurent, and PIRLA investigator group
J. Bone Joint Infect., 9, 37–48, https://doi.org/10.5194/jbji-9-37-2024, https://doi.org/10.5194/jbji-9-37-2024, 2024
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We define an algorithm to optimize bone and joint infection diagnosis in adults on synovial fluid samples. This prospective multi-center study included a large number of synovial fluids and compared the performance of classical culture on different media, inoculation of synovial fluid in blood culture bottles, and broad-range and specific PCR. We proposed an algorithm associating culture onto three solid media and into blood culture bottles and 16S, Staphylococcus, and Streptococcus PCR.
Jorrit Willem Adriaan Schoenmakers, Rosanne de Boer, Lilli Gard, Greetje Anna Kampinga, Marleen van Oosten, Jan Maarten van Dijl, Paulus Christiaan Jutte, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 8, 45–50, https://doi.org/10.5194/jbji-8-45-2023, https://doi.org/10.5194/jbji-8-45-2023, 2023
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In a first evaluation, the accuracy of a novel multiplex PCR (polymerase chain reaction) panel for rapid detection of pathogens in patients with a clinical suspicion of acute septic arthritis of native and prosthetic joints is assessed. Clear benefit is seen in patients with a suspected native septic arthritis and late acute prosthetic joint infection. This indicates that the panel allows for fast tailoring of antibiotics and may prompt the surgeon for surgical lavage in doubtful clinical cases.
Marjan Wouthuyzen-Bakker and Alexander L. Boerboom
J. Bone Joint Infect., 7, 33–34, https://doi.org/10.5194/jbji-7-33-2022, https://doi.org/10.5194/jbji-7-33-2022, 2022
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This case illustrates the clinical picture of a worn-out elbow prosthesis resulting in severe metallosis and a subsequent periprosthetic joint infection.
Karsten D. Ottink, Stefan J. Gelderman, Marjan Wouthuyzen-Bakker, Joris J. W. Ploegmakers, Andor W. J. M. Glaudemans, and Paul C. Jutte
J. Bone Joint Infect., 7, 1–9, https://doi.org/10.5194/jbji-7-1-2022, https://doi.org/10.5194/jbji-7-1-2022, 2022
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A low-grade periprosthetic joint infection (PJI) may be difficult to diagnose, and nuclear imaging could help in the diagnosis. However, its diagnostic value is unclear. We retrospectively evaluated this diagnostic value. We conclude that in patients presenting with nonspecific symptoms and a low a priori chance of PJI based on clinical evaluation, nuclear imaging is of no clear added value in diagnosing a PJI.
Simon Martin Heinrich, Parham Sendi, and Martin Clauss
J. Bone Joint Infect., 6, 423–424, https://doi.org/10.5194/jbji-6-423-2021, https://doi.org/10.5194/jbji-6-423-2021, 2021
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We report on an 83-year-old woman who had an open removal of a baker's cyst several months after total knee arthroplasty. The following wound healing problem was first misinterpreted as being superficial. With an injection of methylene blue and a contrast medium, we showed the extent of the sinus tract, proving the periprosthetic joint infection.
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Short summary
This study conducted in multiple sites across Europe aimed to evaluate the BIOFIRE Joint Infection (JI) Panel, a new technology that uses multiplex PCR to detect microorganisms in synovial fluid of patients with suspicion of joint infections in 1 h, in comparison with synovial fluid culture. Results showed an overall agreement of 85 % to 88.4 % between the two methods. The JI Panel detected additional organisms, and the positive user experience highlights its clinical significance.
This study conducted in multiple sites across Europe aimed to evaluate the BIOFIRE Joint...
