{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T08:50:09Z","timestamp":1772095809840,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:00:00Z","timestamp":1609200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal Orthopaedic Research"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Synovial fluid is important for the preoperative etiological diagnosis of suspected periprosthetic joint infection (PJI) or septic arthritis (SA). GENECUBE, an automated real\u2010time polymerase chain reaction (PCR) assay, was used to detect bacterial <jats:italic>mecA<\/jats:italic> (methicillin resistance) and was compared with microbiological cultures for preoperatively diagnosing PJI and SA in 74 patients suspected of these infections and thus earmarked for surgery. PJI and SA were diagnosed in 21 and 6 cases, respectively, using modified ICM 2018 diagnostic criteria. Microbiological cultures determined methicillin\u2010resistant <jats:italic>staphylococcus<\/jats:italic> (MRS) as the causative organism in six samples, which were all positive in the GENECUBE assay. Significantly also, the GENECUBE assay detected six MRS infections in culture\u2010negative but infection\u2010diagnosed patients, and in one inconclusive case, suggesting a higher sensitivity of this assay. Compared with microbiological culture, the sensitivity and specificity of the GENECUBE assay for <jats:italic>mecA<\/jats:italic>was 100% and 92.2%, respectively. However, GENECUBE also produced invalid results in three cases, suggesting possible PCR inhibitors in the synovial fluid samples. We additionally validated the accuracy of pan\u2010bacterial real\u2010time PCR targeting 16S rRNA and other tests. Pan\u2010bacterial real\u2010time PCR was as effective as preoperative bacterial culture testing, although the \u03b1\u2010defensin assay had the highest sensitivity at 100%. Hence, fully automated real\u2010time PCR targeting of the bacterial <jats:italic>mecA<\/jats:italic> gene improves the etiological diagnosis of PJI and SA by reducing the testing time and lowering the false\u2010positive detection rates. A screening approach for \u03b1\u2010defensin followed by bacterial <jats:italic>mecA<\/jats:italic> gene testing in synovial fluids is therefore a more efficient method of preoperatively diagnosing PJI and SA.<\/jats:p>","DOI":"10.1002\/jor.24959","type":"journal-article","created":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T07:49:16Z","timestamp":1608277756000},"page":"348-355","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["An automated real\u2010time PCR assay for synovial fluid improves the preoperative etiological diagnosis of periprosthetic joint infection and septic arthritis"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3160-8652","authenticated-orcid":false,"given":"Fan","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Yokohama City University  Yokohama Japan"},{"name":"Department of Orthopaedic Surgery Guangzhou 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