Novel strategies to diagnose prosthetic or native bone and joint infections

ABSTRACT

Introduction

Bone and Joint Infections (BJI) are medically important, costly and occur in native and prosthetic joints. Arthroplasties will increase significantly in absolute numbers over time as well as the incidence of Prosthetic Joint Infections (PJI). Diagnosis of BJI and PJI is sub-optimal. The available diagnostic tests have variable effectiveness, are often below standard in sensitivity and/or specificity, and carry significant contamination risks during the collection of clinical samples. Improvement of diagnostics is urgently needed.

Areas covered

We provide a narrative review on current and future diagnostic microbiology technologies. Pathogen identification, antibiotic resistance detection, and assessment of the epidemiology of infections via bacterial typing are considered useful for improved patient management. We confirm the continuing importance of culture methods and successful introduction of molecular, mass spectrometry-mediated and next-generation genome sequencing technologies. The diagnostic algorithms for BJI must be better defined, especially in the context of diversity of both disease phenotypes and clinical specimens rendered available.

Expert opinion

Whether interventions in BJI or PJI are surgical or chemo-therapeutic (antibiotics and bacteriophages included), prior sensitive and specific pathogen detection remains a therapy-substantiating necessity. Innovative tests for earlier and more sensitive and specific detection of bacterial pathogens in BJI are urgently needed.

KEYWORDS:

• BJI
• PJI
• diagnostics
• Staphylococcus aureus
• coagulase negative staphylococci
• biofilms
• antibiotic treatment
• alternative therapy

ARTICLE HIGHLIGHTS

• This review summarizes the limitations of current diagnostic tests and investigates the need for additional (molecular and genomic) tests for BJI and PJI.

• The clinical definition and diagnostic approaches for BJI and PJI need continuous updating especially for fastidious organisms.

• Novel molecular tests should cover all relevant microbial species and key antibiotic resistance markers in multiplex amplification assays as well as biomarkers for host infection susceptibility; such tests should be supported by immunological and sequencing-based formats.

• Antimicrobial susceptibility testing of BJI and PJI causing organisms needs optimization.

Acknowledgments

The authors gratefully acknowledge the help provided by Isabelle Caniaux, Christine Franceschi, Barbara Mauerhofer and Virginie Moucadel (all bioMérieux, France) in exploring and defining the positioning of molecular diagnostics in the field of BJI.

Author contribution statement

All authors have substantially contributed to the conception and design of the review article and the interpretation of the relevant literature. All authors participated in writing and editing for intellectual content.

Declaration of interest

C Ginocchio, C Jay, MF Gros, and A van Belkum are employees of bioMérieux, a company developing and selling diagnostic tests in the field of medical microbiology. The conclusions in the paper are the ones formulated by the author(s) and do not necessarily represent company standpoints. All other authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject discussed in the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.