Multicentre prospective evaluation of histological and molecular criterion for diagnosis of prosthetic-joint infection

Objectives: This multicenter prospective study was performed to assess the contribution of broad range PCR diagnosis in prosthetic-joint infection (PJI). Methods: Adult patients treated for PJI at 7 centers were included between December 2010 and March 2012. Six per-operative samples were obtained for each patient, 5 for conventional cultures and 16S rRNA gene real-time PCR followed by sequencing, and 1 for histopathological classification according to Morawietz. Cultures and PCR were performed in a highly standardized manner, with 3 quality controls of PCR analyses. An infection was considered as proved (3 criteria: per-operative, bacteriological and histological), probable (clinical or bacteriological criterium), or excluded (no criterium). Molecular criterium for predicting PJI was determined using the bacteriological one as reference (>=1 positive sample for virulent organism, and >=3 positive samples for coagulase-negative staphylococci (CoNS) and P. acnes). Results: 299 patients were included, 264 with suspicion of sepsis (S) and 35 as controls (C). The 264 S presented with acute (19%), or chronic suspicion of PJI (81%). Infection was proved or probable in 212/264 S (80%), with the bacteriological criterium in 189/212 S (89%). Out of these, 156 (83%) had monomicrobial and 33 (17%) polymicrobial infections. The isolated pathogens were S. aureus (40%), CoNS (25%), streptococci (14%), Gram-Negative rods (10%), and anaerobes 8%. Histology results were not available for 55 patients, leaving 244 patients available for analysis. Histological findings of infection (Morawietz types II or III) were present in 128/169 (76%) proved or probable infections, in 3 patients without any other criterium, and were absent in excluded infections (n=42) and controls (n=29). PCR results were not analysable for 32 patients (S=28, C=4), leaving 267 patients (S=236, C=31) available for analysis. Molecular criterium of infection was present in 63/68 (93%) proved infections, 83/124 (67%) probable infections, 3/42 excluded infections, 0/2 histological criterium alone and 2/31 controls. Molecular criterium of infection was absent in 34/189 (18%) culture-positive S, and present in 8/23 culture-negative S (8 patients treated with antibiotics). Conclusions: According to this multicenter prospective study, 16S rRNA gene real-time PCR is less susceptible than culture for diagnosis of PJI. Molecular analysis could be recommended in culture-negative patients who were receiving antibiotics

Evaluation of 16S rRNA gene PCR sensitivity and specificity for diagnosis of prosthetic joint infection: a prospective multicenter cross-sectional study

There is no standard method for the diagnosis of prosthetic joint infection (PJI). The contribution of 16S rRNA gene PCR sequencing on a routine basis remains to be defined. We performed a prospective multicenter study to assess the contributions of 16S rRNA gene assays in PJI diagnosis. Over a 2-year period, all patients suspected to have PJIs and a few uninfected patients undergoing primary arthroplasty (control group) were included. Five perioperative samples per patient were collected for culture and 16S rRNA gene PCR sequencing and one for histological examination. Three multicenter quality control assays were performed with both DNA extracts and crushed samples. The diagnosis of PJI was based on clinical, bacteriological, and histological criteria, according to Infectious Diseases Society of America guidelines. A molecular diagnosis was modeled on the bacteriological criterion (≥ 1 positive sample for strict pathogens and ≥ 2 for commensal skin flora). Molecular data were analyzed according to the diagnosis of PJI. Between December 2010 and March 2012, 264 suspected cases of PJI and 35 control cases were included. PJI was confirmed in 215/264 suspected cases, 192 (89%) with a bacteriological criterion. The PJIs were monomicrobial (163 cases [85%]; staphylococci, n = 108; streptococci, n = 22; Gram-negative bacilli, n = 16; anaerobes, n = 13; others, n = 4) or polymicrobial (29 cases [15%]). The molecular diagnosis was positive in 151/215 confirmed cases of PJI (143 cases with bacteriological PJI documentation and 8 treated cases without bacteriological documentation) and in 2/49 cases without confirmed PJI (sensitivity, 73.3%; specificity, 95.5%). The 16S rRNA gene PCR assay showed a lack of sensitivity in the diagnosis of PJI on a multicenter routine basis

Observatoire régional du pneumocoque en région Pays de la Loire : résistance de Streptococcus pneumoniae aux antibiotiques en 2007

But de l’étudeEntre le 1er janvier et le 31 décembre 2007, les 20 laboratoires participant à l’observatoire régional du pneumocoque (ORP) Pays de la Loire ont collecté 331 souches invasives de Streptococcus pneumoniae afin d’étudier leur sensibilité aux antibiotiques et la répartition des sérogroupes/sérotypes. Méthode Les concentrations minimales inhibitrices (CMI) de la pénicilline G, de l’amoxicilline et du céfotaxime ont été déterminées par le centre coordinateur, par la méthode de référence de diffusion en milieu gélosé. Les résultats ont été interprétés selon les recommandations du CA-SFM. Les sensibilités à d’autres antibiotiques ont été étudiées et les typages des souches réalisées par le centre coordinateur. Résultats Trois cent trente et une souches ont été isolées en 2007. Elles provenaient de 30 liquides céphalorachidiens, 239 hémocultures, 53 pus d’otites moyennes aiguës et neuf liquides pleuraux. Le pourcentage de pneumocoques de sensibilité diminuée à la pénicilline G (PSDP) était de 39 % et restait plus élevé chez l’enfant (51 %) que chez l’adulte (35 %). Les PSDP étaient souvent multirésistants, avec en particulier un pourcentage élevé de résistance à l’érythromycine (87,6 % contre 8,4 % pour les pneumocoques sensibles à la pénicilline). Enfin, le sérogroupe majoritairement rencontré était le sérogroupe 19 (29,6 % des isolats). Conclusion Une diminution des PSDP a été observée depuis 2001 et les souches de haut niveau de résistance aux β-lactamines restent rares. Le pourcentage de PSDP observés en ORP Pays de la Loire demeure dans la moyenne nationale

Observatoire Régional du Pneumocoque en région Pays de la Loire : résistance de Streptococcus pneumoniae aux antibiotiques en 2013

National audienc

Corporeality, equality and education. A biopedagogical perspective

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Observatoire Régional du Pneumocoque en région Pays de la Loire : résistance de Streptococcus pneumoniae (Sp) aux antibiotiques en 2007

Date du colloque&nbsp;: 12/2008</p