The impact of PCR in the management of prosthetic joint infections

Abstract

An accurate diagnosis of prosthetic joint infection (PJI) remains a challenging clinical problem and is essential for the success of treatment regardless of the treatment option chosen by patients and surgeons. In recent years, PCR for the diagnosis of PJI has received much attention. Here, we review the impact of common PCR-based techniques on identifying causative organisms, antibiotic management and economics of PJI.

Keywords:

• 16S PCR
• PJI
• prosthetic joint
• PCR
• sonication

Acknowledgments

The authors would like to thank Hampshire Hospitals library staff for their support in obtaining various references and reports.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Diagnosis of prosthetic joint infection (PJI) remains a challenge in clinical practice.

• The fact that culture negative PJI cases occur, biomarkers and molecular techniques, such as PCR, will remain helpful in the diagnosis of these cases.

• Sensitivity is reduced with broad range 16S rPCR compared with species-specific PCR, negative results do not exclude bacterial infection and tests should be used as part of other clinical information and investigations.

• Most reports on PCR in PJI conclude that the technique can be a valuable tool for managing antibiotics; while we agree with this, formal studies would be required to confirm this.

• Formal studies may be required to look at costs of PCR in PJI and its impact on the health economy.

• The rapid turnaround time for PCR can only aid patient management and antimicrobial stewardship.