PMID- 30653049
OWN - NLM
STAT- MEDLINE
DCOM- 20191021
LR  - 20191022
IS  - 1535-1386 (Electronic)
IS  - 0021-9355 (Linking)
VI  - 101
IP  - 2
DP  - 2019 Jan 16
TI  - Fluorescence in Situ Hybridization (FISH) for the Diagnosis of Periprosthetic 
      Joint Infection in Formalin-Fixed Paraffin-Embedded Surgical Tissues.
PG  - e5
LID - 10.2106/JBJS.18.00243 [doi]
AB  - BACKGROUND: As the number of arthroplasties performed increases, periprosthetic 
      joint infection (PJI) represents a common and challenging problem. The 
      Musculoskeletal Infection Society (MSIS) recommends diagnosing PJI according to 
      its guidelines. The aim of the current study was to assess whether fluorescence 
      in situ hybridization (FISH) analysis of formalin-fixed paraffin-embedded 
      periprosthetic membranes can successfully improve the diagnosis of infection in 
      patients with orthopaedic implants. METHODS: We retrospectively analyzed 88 
      periprosthetic membranes of joint prostheses using FISH analysis according to a 
      standard protocol, with a probe targeting a sequence found in most bacteria. We 
      compared the results with routine clinical classification according to the 
      guidelines of the MSIS, microbiological culture, and histopathological 
      classification according to Morawietz and Krenn. We additionally performed FISH 
      analysis using 2 species-specific probes for several culture-positive cases. 
      RESULTS: FISH successfully detected bacteria in 38 (95%) of 40 periprosthetic 
      membranes that were rated positive by clinical classification. FISH results 
      compared with clinical classification demonstrated a sensitivity of 95% (95% 
      confidence interval [CI], 83.08% to 99.39%), a specificity of 85.42% (95% CI, 
      72.24% to 93.93%), a positive predictive value of 84.44% (95% CI, 70.55% to 
      93.50%), and a negative predictive value of 95.35% (95% CI, 84.19% to 99.43%). 
      FISH results compared with histopathological classification demonstrated a 
      sensitivity of 95.12% (95% CI, 83.47% to 99.40%), a specificity of 87.23% (95% 
      CI, 74.26% to 95.17%), a positive predictive value of 86.67% (95% CI, 73.21% to 
      94.95%), and a negative predictive value of 95.35% (95% CI, 84.19% to 99.43%). We 
      successfully detected Pseudomonas aeruginosa and Staphylococcus aureus with 
      species-specific FISH probes in all cases that were positive for these respective 
      bacteria by microbiological culture. CONCLUSIONS: FISH-based diagnosis of PJI is 
      feasible and can be used as an additional diagnostic criterion. FISH not only can 
      detect bacteria in periprosthetic membranes but can also differentiate pathogens 
      at the species level. FISH represents a fast and reliable tool for detecting PJI 
      in periprosthetic membranes, especially in combination with clinical and 
      histopathological classification. LEVEL OF EVIDENCE: Diagnostic Level III. See 
      Instructions for Authors for a complete description of levels of evidence.
FAU - Lippmann, Torsten
AU  - Lippmann T
AD  - Institute of Pathology (T.L., P.B., M.K., F.L., and D.J.) and Department of 
      Orthopaedic Surgery (M.E.), Hannover Medical School (MHH), Hannover, Germany.
FAU - Braubach, Peter
AU  - Braubach P
AD  - Institute of Pathology (T.L., P.B., M.K., F.L., and D.J.) and Department of 
      Orthopaedic Surgery (M.E.), Hannover Medical School (MHH), Hannover, Germany.
FAU - Ettinger, Max
AU  - Ettinger M
AD  - Institute of Pathology (T.L., P.B., M.K., F.L., and D.J.) and Department of 
      Orthopaedic Surgery (M.E.), Hannover Medical School (MHH), Hannover, Germany.
FAU - Kuehnel, Mark
AU  - Kuehnel M
AD  - Institute of Pathology (T.L., P.B., M.K., F.L., and D.J.) and Department of 
      Orthopaedic Surgery (M.E.), Hannover Medical School (MHH), Hannover, Germany.
FAU - Laenger, Florian
AU  - Laenger F
AD  - Institute of Pathology (T.L., P.B., M.K., F.L., and D.J.) and Department of 
      Orthopaedic Surgery (M.E.), Hannover Medical School (MHH), Hannover, Germany.
AD  - Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), 
      German Center for Lung Research (Deutsches Zentrum fur Lungenforschung [DZL]), 
      Hannover, Germany.
FAU - Jonigk, Danny
AU  - Jonigk D
AD  - Institute of Pathology (T.L., P.B., M.K., F.L., and D.J.) and Department of 
      Orthopaedic Surgery (M.E.), Hannover Medical School (MHH), Hannover, Germany.
AD  - Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), 
      German Center for Lung Research (Deutsches Zentrum fur Lungenforschung [DZL]), 
      Hannover, Germany.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Bone Joint Surg Am
JT  - The Journal of bone and joint surgery. American volume
JID - 0014030
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Arthritis, Infectious/*diagnosis
MH  - Female
MH  - Humans
MH  - *In Situ Hybridization, Fluorescence
MH  - Male
MH  - Middle Aged
MH  - Paraffin Embedding
MH  - Predictive Value of Tests
MH  - Prosthesis-Related Infections/*diagnosis
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
EDAT- 2019/01/18 06:00
MHDA- 2019/10/23 06:00
CRDT- 2019/01/18 06:00
PHST- 2019/01/18 06:00 [entrez]
PHST- 2019/01/18 06:00 [pubmed]
PHST- 2019/10/23 06:00 [medline]
AID - 00004623-201901160-00011 [pii]
AID - 10.2106/JBJS.18.00243 [doi]
PST - ppublish
SO  - J Bone Joint Surg Am. 2019 Jan 16;101(2):e5. doi: 10.2106/JBJS.18.00243.