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. 2025 Oct;111(6):104032.
doi: 10.1016/j.otsr.2024.104032. Epub 2024 Oct 29.

Performance of the GeneXpert® MRSA/SA SSTI test in periprosthetic joint infections: rate of failure, outcomes and risk factors

Jean-Thomas Leclerc  1 , Marie Titécat  2 , Theo Martin  3 , Julien Dartus  3 , Sophie Putman  4 , Pierre Martinot  3 , François Demaeght  5 , Caroline Loïez  6 , Philippe-Alexandre Faure  3 , Gilles Pasquier  3 , Julien Girard  3 , Alain Duhamel  7 , Eric Senneville  8 , Henri Migaud  9
Affiliations

Performance of the GeneXpert® MRSA/SA SSTI test in periprosthetic joint infections: rate of failure, outcomes and risk factors

Jean-Thomas Leclerc et al. Orthop Traumatol Surg Res. 2025 Oct.

Abstract

Background: The GeneXpert® MRSA/SA SSTI test allows early detection of methicillin-resistant staphylococci in intraoperative samples of prosthetic joint infections (PJI) in order to stop early broad-spectrum antibiotics.

Questions/purpose: (1) What is the rate of false-negative GeneXpert® MRSA/SA SSTI test results? (2) Does a false-negative GeneXpert® MRSA/SA SSTI test result increase the risk of treatment failure for the patient with a PJI? (3) What are the risk factors of a false-negative result?

Method: A retrospective study was carried out to compare all GeneXpert® assays to conventional cultures in prosthetic joint infections from April 1st, 2012 to October 1st, 2016. False-negative (FN) results (absence of methicillin-resistant staphylococci (MRS) with GeneXpert® test, but presence in the culture) were identified. We compared the rate of treatment failure between FN results and other test results and we established the risk factors of having a FN result.

Results: Among the 612 GeneXpert® results, the rate of FN results was 3.6 % (22/612). We found a significant increase in treatment failures for prosthetic joint infection with a FN result with 14 treatment failures (14/22) compared to 198 treatment failures (198/590) in the other test results (OR, 2.1; 95 % CI, 1.3-3.4, p = 0.0019). Not considering suppressive antibiotics as a treatment failure, we found no significant difference in the rate of treatment failures between the false-negative tests and the other tests (OR, 1.36; 95 % CI, 0.66-2.81, p = 0.41). Tobacco use (OR, 3.8; 95 % CI, 1.4-10.3, p = 0.004), ASA classification (OR, 2,4; 95 % CI, 0.9-6.9, p = 0.064), history of infection in the joint (OR, 3.2; 95 % CI, 1.2-9.6, p = 0.007), chronic infections (OR, 3.2; 95 % CI, 0.8-17.5, p = 0.01) and polymicrobial infections (OR, 3.2; 95 % CI, 1.1-9.2, p < 0.0001) were risk factors for a FN result.

Conclusion: GeneXpert® tests in prosthetic joint infections showed a low rate of FN results. An increased risk of treatment failures was observed in FN results only when long-term use of suppressive antibiotics was considered as treatment failure.

Level of evidence: III; Diagnostic retrospective case control study.

Keywords: GeneXpert MRSA/SA SSTI assay; Infection diagnosis test; Methicillin-Resistant staphylococci; Prosthetic joint infection.

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Conflict of interest statement

Declaration of competing interest HM declares being chief editor of Orthopaedics & Traumatology: Surgery & Research and perceives fees outside the scope of this study as educational consultant from Zimmer-Biomet, Corin SERF and MSD. Jean-Thomas Leclerc perceives fees outside the scope of this study as educational consultant from Zimmer-Biomet, Smith and Nephews and Pendopharm. Théo Martin, Marie Titécat, François Demaeght, Philippe Alexandre Faure, and Alain Duhamel do not declare any conflicts of interest in relation to or outside of this study. Pierre Martinot and Julien Dartus received a grant from SOFCOT for fellowship. Caroline Loïez declares, outside of this study, that she receives fees as an education consultant from Eumedica, MSD and Novartis. Outside of this study, Eric Senneville declares that he is a consultant for MSD Correvio, Sanofi, Bayer, Novartis and Zimmer-Biomet. Outside the scope of the current study, Sophie Putman declares fees from Corin as consultant. Gilles Pasquier declares fees from Zimmer-Biomet. Julien Girard declares fees from Corin, Smith and Nephews and Mathys.

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