Isothermal microcalorimetry improves accuracy and time to bacterial detection of periprosthetic joint infection after total joint arthroplasty

Abstract

Isothermal microcalorimetry (IMC) was evaluated compared to conventional cultures to determine the clinical performance for diagnosing periprosthetic joint infection (PJI) of hip/knee replacements. We prospectively collected three to five deep tissue samples per patient from 152 patients undergoing conversion or revision hip/knee arthroplasty from July 2020 to November 2022. Cultures and IMC for each sample were compared for concordance, median time to detection (TTD), and diagnostic performance based on 2013 Musculoskeletal Infection Society criteria. Secondary analyses involved patients on antibiotics at sampling. The 152 total patients had 592 tissue samples (mean 3.9 ± 0.3) with sample concordance between cultures and IMC of 90%. IMC demonstrated a sensitivity of 83%, specificity of 100%, negative predictive value (NPV) of 89%, and positive predictive value (PPV) of 100% for PJI. Cultures resulted in 69% sensitivity, 100% specificity, 81% NPV, and 100% PPV. The accuracy of IMC was 93% compared to 87% for cultures (P < 0.001). The median TTD of PJI by cultures was 51 (21-410) hours compared to 10 (0.5-148) hours for IMC (P < 0.001). For 39 patients on chronic antibiotics, sensitivity in PJI detection was 93%, specificity 100%, NPV 85%, and PPV 100% by IMC compared to 79% sensitivity, 100% specificity, 65% NPV, and 100% PPV for cultures. The accuracy was 95% for IMC compared to 85% for cultures (P < 0.001) with median TTD of 12 (0.5-127) hours compared to 52 (21-174) hours (P < 0.001). Utilizing IMC for PJI detection improves TTD by nearly 2 days while improving diagnostic accuracy compared to cultures, particularly in patients on chronic antibiotics.

Keywords: arthroplasty; calScreener; calorimetry; diagnosis; infection; isothermal microcalorimetry; periprosthetic joint infection.

Fig 1

Heat flow (μW) thermograms representing six unique bacterial species detected by isothermal microcalorimetry from multiple individual patients (infections) with monomicrobial periprosthetic joint infections, all analyzed in tryptic soy broth. The bacterial species included (A) Enterobacter cloacae complex, (B) Pseudomonas aeruginosa, (C) Serratia marcescens, (D) methicillin-resistant Staphylococcus aureus (MRSA), (E) methicillin-sensitive Staphylococcus aureus (MSSA), and (F) Staphylococcus epidermidis.

Fig 2

Heat flow (μW) thermograms from six separate individual monomicrobial periprosthetic joint infections of unique bacterial species detected by isothermal microcalorimetry, all analyzed in tryptic soy broth.

Fig 3

Cumulative of time to detection for positive sample identification of isothermal microcalorimetry and conventional cultures. By 30 hours, 75% of isothermal microcalorimetry samples were positive compared to 9% of culture samples, as represented by the pink dashed lines.