ABSTRACT

Introduction

Bone and Joint Infections (BJI) are medically important, costly and occur in native and prosthetic joints. Arthroplasties will increase significantly in absolute numbers over time as well as the incidence of Prosthetic Joint Infections (PJI). Diagnosis of BJI and PJI is sub-optimal. The available diagnostic tests have variable effectiveness, are often below standard in sensitivity and/or specificity, and carry significant contamination risks during the collection of clinical samples. Improvement of diagnostics is urgently needed.

Areas covered

We provide a narrative review on current and future diagnostic microbiology technologies. Pathogen identification, antibiotic resistance detection, and assessment of the epidemiology of infections via bacterial typing are considered useful for improved patient management. We confirm the continuing importance of culture methods and successful introduction of molecular, mass spectrometry-mediated and next-generation genome sequencing technologies. The diagnostic algorithms for BJI must be better defined, especially in the context of diversity of both disease phenotypes and clinical specimens rendered available.

Expert opinion

Whether interventions in BJI or PJI are surgical or chemo-therapeutic (antibiotics and bacteriophages included), prior sensitive and specific pathogen detection remains a therapy-substantiating necessity. Innovative tests for earlier and more sensitive and specific detection of bacterial pathogens in BJI are urgently needed.

中文翻译：

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诊断假体或天然骨和关节感染的新策略

摘要

介绍

骨和关节感染 (BJI) 在医学上很重要，成本高，并且发生在天然和假体关节中。随着时间的推移，关节成形术的绝对数量以及假体关节感染 (PJI) 的发生率将显着增加。BJI 和 PJI 的诊断并不理想。可用的诊断测试具有不同的有效性，通常在敏感性和/或特异性方面低于标准，并且在收集临床样本期间具有显着的污染风险。迫切需要改进诊断。

涵盖的领域

我们对当前和未来的诊断微生物学技术进行叙述性回顾。病原体鉴定、抗生素耐药性检测和通过细菌分型评估感染流行病学被认为有助于改善患者管理。我们确认了培养方法的持续重要性以及分子、质谱介导和下一代基因组测序技术的成功引入。必须更好地定义 BJI 的诊断算法，尤其是在疾病表型和可用临床标本的多样性背景下。

专家意见

无论 BJI 或 PJI 的干预是手术还是化疗（包括抗生素和噬菌体），事先敏感和特异性的病原体检测仍然是治疗证实的必要性。迫切需要对 BJI 中的细菌病原体进行更早、更灵敏和特异性检测的创新测试。