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Molecular diagnostics examples1/9/2024 Standard microbiologic tests diagnosed infection in <25% of these patients. In 1999, Tunney et al 8 used molecular detection methods to diagnose prosthetic hip infections and found evidence of bacterial colonization in >60% of retrieved arthroplasty samples from 120 patients. With strong demand for more appropriate and rapid detection of organisms, new technology is redefining how we diagnose infections and expanding our knowledge of the organisms involved in colonizing and infecting wounds and prostheses. However, treatment currently relies mainly on microbiological cultures. 7 These studies have demonstrated the detection of specific synovial proteins as diagnostic biomarkers for PJI.ĭetection of causative organisms, which is directly relevant to antibacterial treatment, remains an important challenge in the management of orthopaedic infections. 3– 6 Described biomarkers include α-defensin, interleukin-1, interleukin-6, and neutrophil elastase, among others. 3 Several studies have systematically examined the synovial fluid proteome in relationship to PJI and have identified two protein families that provide a good diagnostic value for PJI: antimicrobial peptides and cytokines. Because infection-related biomarker levels in synovial fluid should be much greater than those in blood, it makes sense to specifically target the biomarkers in synovial fluid. For the past decade, proteomics research has been active in the field of orthopaedics, with researchers attempting to identify biomarkers for PJI in blood and synovial fluid. The term proteomics describes a contemporary approach of analyzing proteins to identify diagnostic biomarkers for a disease. However, studies have shown that a threshold blood CRP level of 10 mg/L provides a sensitivity and specificity of approximately 70% to 90% for detection of chronic PJI. It is sometimes regarded as nonspecific for diagnosis of infections because the CRP level may be increased by other inflammatory processes. This test has been available for years and is commonly used by surgeons. 1, 2 CRP is also an archetypal blood biomarker for periprosthetic joint infections (PJIs). Currently, the CRP test is one of the most universally used blood biomarker tests for clinical infections. For example, detection of β-human chorionic gonadotropin in blood or urine is used to diagnose pregnancy, and the detection of cardiac troponin is used to diagnose myocardial infarction. Some of the most popular and cost-effective diagnostic tests in medicine are based on quantification of a specific protein and are used frequently in hospitals across the world. Recent advances in molecular diagnostics are beginning to shift from basic research to clinical reality. Here, we present the current applications of molecular diagnostic tests as well as their advantages, limitations, and future directions for the diagnosis and personalized treatment of orthopaedic infections.Ĭurrent Applications of Molecular Techniques Accurate and rapid diagnosis of an infection is still sometimes the most difficult aspect of managing orthopaedic infections. In some cases, cultures produce false-negative results because of the use of empiric antibiotics or because low-virulence bacteria require specific nutrients to be grown in cultures. Culture of tissue or fluid remains the current standard of care for diagnosing infections, but this method is not sensitive and can be time-consuming. Although blood-based tests (eg, C-reactive protein level, cell count) can suggest the presence of infection, they are not able to determine the species or antibiotic sensitivities of infecting organisms. Universal diagnostics for these infections are still lacking. Surgical site and postoperative infections are among the most common and severe complications that affect orthopaedic patients.
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