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The etiologic diagnosis of infectious discitis is improved by amplification-based DNA analysis.

Onglets principaux

Lecouvet, Frédéric [UCL] Irenge, Leonid Vandercam, Bernard [UCL] Nzeusseu, Adrien [UCL] Hamels, Sandrine Gala, Jean-Luc [UCL]

OBJECTIVE: Blood cultures and cultures of disc material are required to identify and treat bacterial agents responsible for septic spondylodiscitis, but these methods have limited sensitivities. We undertook this study to compare nonculture amplification-based DNA analysis with conventional culture of disc aspirate. METHODS: Nineteen patients with spondylodiscitis, including 11 with a history of spinal surgery, presented with negative blood cultures and underwent percutaneous disc or epidural abscess puncture for bacterial diagnosis. Amplification by polymerase chain reaction was performed on 16S ribosomal DNA universal target genes and femA staphylococci-specific target genes in all patients, and on the upstream p34 mycobacterial gene in 1 patient. Species identification relied on amplicon sequencing and comparison with templates from GenBank. Amplification of the femA gene led to subsequent testing for methicillin resistance by amplification of the mecA gene. Further assessment using a staphylococci- and methicillin resistance-specific DNA array was performed on 3 samples. RESULTS: Microbiologic and molecular assays identified the causative organism in 14 of 19 patients (74%) and 19 of 19 patients (100%), respectively. In culture-positive patients, DNA-based and microbiologic results were highly correlated. Five agents (Staphylococcus simulans, Staphylococcus sciuri, Brucella species, Actinomyces israelii, and Mycobacterium tuberculosis complex) were identified only by DNA-based methods. In 1 sample, Corynebacterium jeikeium and coagulase-negative Staphylococcus were both cultured, whereas DNA analysis identified only Staphylococcus hominis. CONCLUSION: DNA-based methods are highly sensitive and specific. They can usefully complement standard microbiologic methods for identifying the cause of infectious spondylodiscitis and contribute to species-specific therapeutic orientation in patients with negative blood and disc aspirate cultures.

Type de document Article de périodique (Journal article) – Article de recherche
Type d'accès Accès restreint
Année de publication 2004
Information sur le périodique "Arthritis & Rheumatism" - Vol. 50, no. 9, p. 2985-2994 (2004)
Peer reviewed oui
Editeur John Wiley & Sons, Inc. (Hoboken)
issn 0004-3591
e-issn 1529-0131
Statut de la publication Publié
Affiliations UCL - MD/RAIM - Département de radiologie et d'imagerie médicale
UCL - MD/MINT - Département de médecine interne
UCL - (SLuc) Service de radiologie
UCL - (SLuc) Service de médecine interne et maladies infectieuses (MIMI)
UCL - (SLuc) Centre de prise en charge (H.I.V.)
UCL - (SLuc) Service de rhumatologie
UCL - (SLuc) Centre de l'allergie
MESH Subject Adult ; Aged ; Bacterial Infections - complications - diagnosis ; Bacteriological Techniques - methods ; Discitis - diagnosis - microbiology ; Female ; Humans ; Male ; Middle Aged ; Nucleic Acid Amplification Techniques - methods
Liens
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Référence bibliographique Lecouvet, Frédéric ; Irenge, Leonid ; Vandercam, Bernard ; Nzeusseu, Adrien ; Hamels, Sandrine ; et. al. The etiologic diagnosis of infectious discitis is improved by amplification-based DNA analysis.. In: Arthritis & Rheumatism, Vol. 50, no. 9, p. 2985-2994 (2004)
Permalien http://hdl.handle.net/2078.1/9978