Next Generation Sequencing for the Detection of Pathogens in Hip Surgery: Experience and Diagnostic Feasibility in a Tertiary Care Center in Argentina
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Published:
Oct 24, 2022
Keywords:
Periprosthetic joint infection, next generation sequencing, revision surgery, hip arthroplasty
Main Article Content
Abstract
Introduction: Early diagnosis of a periprosthetic joint infection (PJI) and identification of the pathogen are paramount. Next-generation sequencing (NGS) can identify the nucleic acids in a given germ in a short period. To our knowledge, there are no reports of its use in the management of PJI in South America. Our objective was to demonstrate the diagnostic feasibility of the NGS technique on the samples obtained from a series of patients operated on in Buenos Aires, Argentina.
Materials and Methods: A prospective series of 20 patients undergoing septic and aseptic hip revision surgery from December 2019 to March 2020 was analyzed. Intraoperative samples of synovial fluid, deep tissue, and intramedullary canal were obtained and sent to the NexGen Microgen laboratory (Texas, USA) for analysis.
Results: Seventeen patients were finally eligible to present a sample suitable for analysis. In 100% of the samples, NGS results were obtained within 72 hours of surgery. In one case, the NGS result reported agerm different from the one identified in the postoperative soft tissue cultures, allowing antibiotic therapy to be corrected. In another case, NGS identified Parabacteroides gordonii in aseptic revision surgery. In another patient, the NGS identified Morganella morganii, in which conventional postoperative cultures were negative in single-stage revision surgery.
Conclusion: In this study, we demonstrated the diagnostic feasibility of NGS, obtaining results within 72 hours immediately after surgery for pathogenic organisms in patients with PJI and negative cultures.
Materials and Methods: A prospective series of 20 patients undergoing septic and aseptic hip revision surgery from December 2019 to March 2020 was analyzed. Intraoperative samples of synovial fluid, deep tissue, and intramedullary canal were obtained and sent to the NexGen Microgen laboratory (Texas, USA) for analysis.
Results: Seventeen patients were finally eligible to present a sample suitable for analysis. In 100% of the samples, NGS results were obtained within 72 hours of surgery. In one case, the NGS result reported agerm different from the one identified in the postoperative soft tissue cultures, allowing antibiotic therapy to be corrected. In another case, NGS identified Parabacteroides gordonii in aseptic revision surgery. In another patient, the NGS identified Morganella morganii, in which conventional postoperative cultures were negative in single-stage revision surgery.
Conclusion: In this study, we demonstrated the diagnostic feasibility of NGS, obtaining results within 72 hours immediately after surgery for pathogenic organisms in patients with PJI and negative cultures.
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How to Cite
Lucero, C. M., García-Mansilla, A., Albani Forneris, A., Díaz Dilernia, F., Slullitel, P., Zanotti, G., Comba, F., Piccaluga, F., & Buttaro, M. (2022). Next Generation Sequencing for the Detection of Pathogens in Hip Surgery: Experience and Diagnostic Feasibility in a Tertiary Care Center in Argentina. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(5), 626-635. https://doi.org/10.15417/issn.1852-7434.2022.87.5.1571
Section
Clinical Research
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References
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https://doi.org/10.1056/NEJMra040181
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6. Parvizi J, Erkocak OF, Della Valle CJ. Culture-negative periprosthetic joint infection. J Bone Joint Surg Am
2014;96(5):430-6. https://doi.org/10.2106/JBJS.L.01793
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8. Mortazavi SMJ, Vegari D, Ho A, Zmistowski B, Parvizi J. Two-stage exchange arthroplasty for infected total knee
arthroplasty: predictors of failure. ClinOrthopRelat Res 2011;469(11):3049-54. https://doi.org/10.1007/s11999-011-2030-8
9. Ryu SY, Greenwood-Quaintance KE, Hanssen AD, Mandrekar JN, Patel R. Low sensitivity of periprosthetic tissue
PCR for prosthetic knee infection diagnosis. DiagnMicrobiol Infect Dis 2014;79(4):448-53. https://doi.org/10.1016/j.diagmicrobio.2014.03.021
10. Villa F, Toscano M, De Vecchi E, Bortolin M, Drago L. Reliability of a multiplex PCR system for diagnosis of early
and late prosthetic joint infections before and after broth enrichment. Int J Med Microbiol 2017;307(6):363-70.
https://doi.org/10.1016/j.ijmm.2017.07.005
11. Huang Z, Wu Q, Fang X, Li W, Zhang C, Zeng H, et al. Comparison of culture and broad-range polymerase chain reaction methods for diagnosing periprosthetic joint infection: analysis of joint fluid, periprosthetic tissue, and sonicated fluid. IntOrthop 2018;42(9):2035-40. https://doi.org/10.1007/s00264-018-3827-9
12. Whitley R. The new age of molecular diagnostics for microbial agents. N Engl J Med 2008;358(10):988-9.
https://doi.org/10.1056/NEJMp0708085
13. Tarabichi M, Shohat N, Goswami K, Alvand A, Silibovsky R, Belden K, et al. Diagnosis of periprostheticjoint
infection: The potential of next-generation sequencing. J Bone Joint Surg Am 2018;100(2):147-54. https://doi.org/10.2106/JBJS.17.00434
14. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, et al. New definition for
periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. ClinOrthopRelat Res
2011;469(11):2992-4. https://doi.org/10.1007/s11999-011-2102-9
15. Buttaro MA, Martorell G, Quinteros M, Comba F, Zanotti G, Piccaluga F. Intraoperative synovial C-reactive protein is as useful as frozen section to detect periprosthetic hip infection. ClinOrthopRelat Res 2015;473(12):3876-81. https://doi.org/10.1007/s11999-015-4340-8
16. Singh JA, Lewallen DG. Patient-level clinically meaningful improvements in activities of daily living and pain after total hip arthroplasty: data from a large US institutional registry. Rheumatology 2013;52(6):1109-18.
https://doi.org/10.1093/rheumatology/kes416
17. Sheth NP, Nelson CL, Springer BD, Fehring TK, Paprosky WG. Acetabular bone loss in revision total hip
arthroplasty: evaluation and management. J Am AcadOrthopSurg 2013;21(3):128-39. https://doi.org/10.5435/JAAOS-21-03-128
18. Sheth NP, Nelson CL, Paprosky WG. Femoral bone loss in revision total hip arthroplasty: evaluation and
management. J Am AcadOrthopSurg 2013;21(10):601-12. https://doi.org/10.5435/JAAOS-21-10-601
19. Mariani P, Buttaro MA, Slullitel PA, Comba FM, Zanotti G, Ali P, et al. Transfusion rate using intravenous
tranexamic acid in hip revision surgery. Hip Int 2018;28(2):194-9. https://doi.org/10.1177/1120700018768655
20. Tarabichi M, Shohat N, Goswami K, Parvizi J. Can next generation sequencing play a role in detecting pathogens in synovial fluid? Bone Joint J 2018;100B(2):127-33. https://doi.org/10.1302/0301-620X.100B2.BJJ-2017-0531.R2
United States. J Arthroplasty 2008;23(7):984-91. https://doi.org/10.1016/j.arth.2007.10.017
2. Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J. Prosthetic joint infection risk after total hip arthroplasty
in the Medicare population. J Arthroplasty 2009;24(6 Suppl):105-9. https://doi.org/10.1016/j.arth.2009.04.027
3. Parisi TJ, Konopka JF, Bedair HS. What is the long-term economic societal effect of periprostheticinfections after THA? A Markov analysis.ClinOrthopRelat Res 2017;475(7):1891-900. https://doi.org/10.1007/s11999-017-5333-6
4. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004;351(16):1645-54.
https://doi.org/10.1056/NEJMra040181
5. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
6. Parvizi J, Erkocak OF, Della Valle CJ. Culture-negative periprosthetic joint infection. J Bone Joint Surg Am
2014;96(5):430-6. https://doi.org/10.2106/JBJS.L.01793
7. Nodzo SR, Bauer T, Pottinger PS, Garrigues GE, Bedair H, Deirmengian CA, et al. Conventional diagnostic
challenges in periprosthetic joint infection. J Am AcadOrthopSurg 2015;23Suppl:S18-25. https://doi.org/10.5435/JAAOS-D-14-00385
8. Mortazavi SMJ, Vegari D, Ho A, Zmistowski B, Parvizi J. Two-stage exchange arthroplasty for infected total knee
arthroplasty: predictors of failure. ClinOrthopRelat Res 2011;469(11):3049-54. https://doi.org/10.1007/s11999-011-2030-8
9. Ryu SY, Greenwood-Quaintance KE, Hanssen AD, Mandrekar JN, Patel R. Low sensitivity of periprosthetic tissue
PCR for prosthetic knee infection diagnosis. DiagnMicrobiol Infect Dis 2014;79(4):448-53. https://doi.org/10.1016/j.diagmicrobio.2014.03.021
10. Villa F, Toscano M, De Vecchi E, Bortolin M, Drago L. Reliability of a multiplex PCR system for diagnosis of early
and late prosthetic joint infections before and after broth enrichment. Int J Med Microbiol 2017;307(6):363-70.
https://doi.org/10.1016/j.ijmm.2017.07.005
11. Huang Z, Wu Q, Fang X, Li W, Zhang C, Zeng H, et al. Comparison of culture and broad-range polymerase chain reaction methods for diagnosing periprosthetic joint infection: analysis of joint fluid, periprosthetic tissue, and sonicated fluid. IntOrthop 2018;42(9):2035-40. https://doi.org/10.1007/s00264-018-3827-9
12. Whitley R. The new age of molecular diagnostics for microbial agents. N Engl J Med 2008;358(10):988-9.
https://doi.org/10.1056/NEJMp0708085
13. Tarabichi M, Shohat N, Goswami K, Alvand A, Silibovsky R, Belden K, et al. Diagnosis of periprostheticjoint
infection: The potential of next-generation sequencing. J Bone Joint Surg Am 2018;100(2):147-54. https://doi.org/10.2106/JBJS.17.00434
14. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, et al. New definition for
periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. ClinOrthopRelat Res
2011;469(11):2992-4. https://doi.org/10.1007/s11999-011-2102-9
15. Buttaro MA, Martorell G, Quinteros M, Comba F, Zanotti G, Piccaluga F. Intraoperative synovial C-reactive protein is as useful as frozen section to detect periprosthetic hip infection. ClinOrthopRelat Res 2015;473(12):3876-81. https://doi.org/10.1007/s11999-015-4340-8
16. Singh JA, Lewallen DG. Patient-level clinically meaningful improvements in activities of daily living and pain after total hip arthroplasty: data from a large US institutional registry. Rheumatology 2013;52(6):1109-18.
https://doi.org/10.1093/rheumatology/kes416
17. Sheth NP, Nelson CL, Springer BD, Fehring TK, Paprosky WG. Acetabular bone loss in revision total hip
arthroplasty: evaluation and management. J Am AcadOrthopSurg 2013;21(3):128-39. https://doi.org/10.5435/JAAOS-21-03-128
18. Sheth NP, Nelson CL, Paprosky WG. Femoral bone loss in revision total hip arthroplasty: evaluation and
management. J Am AcadOrthopSurg 2013;21(10):601-12. https://doi.org/10.5435/JAAOS-21-10-601
19. Mariani P, Buttaro MA, Slullitel PA, Comba FM, Zanotti G, Ali P, et al. Transfusion rate using intravenous
tranexamic acid in hip revision surgery. Hip Int 2018;28(2):194-9. https://doi.org/10.1177/1120700018768655
20. Tarabichi M, Shohat N, Goswami K, Parvizi J. Can next generation sequencing play a role in detecting pathogens in synovial fluid? Bone Joint J 2018;100B(2):127-33. https://doi.org/10.1302/0301-620X.100B2.BJJ-2017-0531.R2