Evaluating Contamination Risk When Aspirating a Prosthetic Joint Using Microbial Next-Generation DNA Sequencing: An In Vitro Study.

Abstract

A challenge in periprosthetic joint infection is the detection of microbiota. Next-generation sequencing (NGS) of microbial ribosomal DNA is one detection method, but false-positive results are of concern. We conducted a simulated joint aspiration study to assess false-positive rates with NGS testing. The simulated joint was a 50-mL bottle of sterile saline. Four techniques (n = 20 per technique) were tested. Fluid aspirates were inserted into sterile vacutainers with different needle exchanges analyzed for potential contamination points. The negative control group (n = 20 per technique) consisted of 80 sterile saline bottles tested directly at the NGS laboratory. Eighty simulated aspirations were performed, two NGS tests per "joint." In three simulated techniques, the positive detection rate was 0.8%. In the fourth technique, where 10 mL of ambient air was aspirated into the syringe, the rate was 10%. The positive detection rate among the negative control bottles was 1.2%. NGS detected DNA signals from sterile saline aspirations using a sterile technique. However, the false-positive rate was low (0.8%). We theorize that positive DNA signals originated from errant microbe contamination from ambient air drawn into the testing needle bore. We advocate needle exchange at every fluid transfer point.