In the Journals

Next-generation sequencing may help identify causative organisms in PJI

Next-generation sequencing, in combination with culture collection, may help identify causative organisms in culture-negative periprosthetic joint infections, according to results published in The Journal of Bone and Joint Surgery.

“Culture-negative periprosthetic joint infection poses a significant burden and can generate considerable uncertainty for both patients and the treating physician,” study co-author Karan Goswami, MD, MRCS, a research fellow and PhD candidate affiliated with the Rothman Institute of Orthopedics, told Healio.com/Orthopedics. “This psychologically impacts the physician-patient relationship, creates ambiguity about treatment journey and is an unacceptable level of care for patients in the 21st century. Our study draws on the advances in the field of genomics since the completion of the Human Genome Project. It applies these technologies to the diagnosis of orthopedic infection and may help target antibiotics and surgical treatment for certain patients.”

Karan Goswami
Javad Parvizi

At the time of surgical procedure, Goswami and colleagues obtained synovial fluid, deep tissue and swabs from 65 revision arthroplasties and 17 primary arthroplasties. The samples were shipped to the laboratory for next-generation sequencing. Researchers also sent deep-tissue specimens to the institutional laboratory for culture.

Results showed infection was identified in 28 revisions, with positive cultures in 17 cases and positive next-generation sequencing in 25 cases. Researchers found concordance between next-generation sequencing and culture in 15 cases.

Next-generation sequencing identified an organism in nine cases of the 11 cases of culture-negative periprosthetic joint infection. Of the 36 aseptic revisions with negative cultures and 17 primary total joint arthroplasties, next-generation sequencing identified microbes in nine cases and six cases, respectively. Although several organisms were detected in most positive samples by next-generation sequencing, results showed one or two organisms were dominant in most patients who were infected.

“The identification of organisms in culture-negative periprosthetic joint infection is promising and could help us provide targeted antimicrobial therapy for these patients,” Javad Parvizi, MD, FRCS, senior author and professor of orthopedic surgery at the Rothman Institute of Orthopedics, told Healio.com/Orthopedics. “The next step is to determine the clinical significance of [next-generation sequencing] NGS signal on treatment outcomes. A multicenter trial is already underway to explore this question.” – by Casey Tingle

 

Disclosures: Parvizi reports he is a paid consultant for Zimmer Biomet, ConvaTec, TissueGene, CeramTec and Ethicon; has stock options with Parvizi Surgical Innovations, Hip Innovation Technology, CD Diagnostics, Corentec, Alphaeon, Joint Purification Systems, Ceribell, MeDAP, MicroGenDx, Cross Current Business Intelligence, Invisible Sentinel, Physician Recommended Nutriceuticals and Intellijoint; and receives royalties from Corentec, Data Trace, Elsevier, Jaypee, SLACK Incorporated and Wolters Kluwer. Goswami reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

Next-generation sequencing, in combination with culture collection, may help identify causative organisms in culture-negative periprosthetic joint infections, according to results published in The Journal of Bone and Joint Surgery.

“Culture-negative periprosthetic joint infection poses a significant burden and can generate considerable uncertainty for both patients and the treating physician,” study co-author Karan Goswami, MD, MRCS, a research fellow and PhD candidate affiliated with the Rothman Institute of Orthopedics, told Healio.com/Orthopedics. “This psychologically impacts the physician-patient relationship, creates ambiguity about treatment journey and is an unacceptable level of care for patients in the 21st century. Our study draws on the advances in the field of genomics since the completion of the Human Genome Project. It applies these technologies to the diagnosis of orthopedic infection and may help target antibiotics and surgical treatment for certain patients.”

Karan Goswami
Javad Parvizi

At the time of surgical procedure, Goswami and colleagues obtained synovial fluid, deep tissue and swabs from 65 revision arthroplasties and 17 primary arthroplasties. The samples were shipped to the laboratory for next-generation sequencing. Researchers also sent deep-tissue specimens to the institutional laboratory for culture.

Results showed infection was identified in 28 revisions, with positive cultures in 17 cases and positive next-generation sequencing in 25 cases. Researchers found concordance between next-generation sequencing and culture in 15 cases.

Next-generation sequencing identified an organism in nine cases of the 11 cases of culture-negative periprosthetic joint infection. Of the 36 aseptic revisions with negative cultures and 17 primary total joint arthroplasties, next-generation sequencing identified microbes in nine cases and six cases, respectively. Although several organisms were detected in most positive samples by next-generation sequencing, results showed one or two organisms were dominant in most patients who were infected.

“The identification of organisms in culture-negative periprosthetic joint infection is promising and could help us provide targeted antimicrobial therapy for these patients,” Javad Parvizi, MD, FRCS, senior author and professor of orthopedic surgery at the Rothman Institute of Orthopedics, told Healio.com/Orthopedics. “The next step is to determine the clinical significance of [next-generation sequencing] NGS signal on treatment outcomes. A multicenter trial is already underway to explore this question.” – by Casey Tingle

 

Disclosures: Parvizi reports he is a paid consultant for Zimmer Biomet, ConvaTec, TissueGene, CeramTec and Ethicon; has stock options with Parvizi Surgical Innovations, Hip Innovation Technology, CD Diagnostics, Corentec, Alphaeon, Joint Purification Systems, Ceribell, MeDAP, MicroGenDx, Cross Current Business Intelligence, Invisible Sentinel, Physician Recommended Nutriceuticals and Intellijoint; and receives royalties from Corentec, Data Trace, Elsevier, Jaypee, SLACK Incorporated and Wolters Kluwer. Goswami reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

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