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Prosthetic Joint Infection Diagnostics: Exploring the Role of Syndromic Testing in Practice

  1. Which diagnostic technology for prosthetic joint infections (PJIs) identifies genes for bacterial ribosomal DNA to detect pathogenic organisms in synovial fluid?
    16S-amplicon targeted next generation sequencing (NGS)
    Syndromic polymerase chain reaction (PCR) testing
    Synovasure® Microbial Identification Test
  2. Which of the following is most accurate regarding syndromic testing as it relates to antibiotic stewardship in PJIs?
    Helps to guide antibiotic selection based on identified organisms
    Proven to decrease antibiotic duration
    Provides susceptibility information for each organism on the panel
    Recommends specific antibiotics to use
  3. A 59-year-old man presents to you with a painful left knee. Twelve years ago, he underwent a total knee arthroplasty, which was followed 7 years later by a 2-stage exchange for an MRSA infection. He has received 3 courses of antibiotics over the past 4 months. A culture of synovial fluid taken 14 days ago was negative. Basic synovial analysis showed 6000 WBCs with 40% neutrophils; ESR was 30 and CRP was 2.5.
    Which of the following tests would be most appropriate for the patient at this point?
    Blood cultures
    Bone scan
    FDG-PET scan
    Repeat aspiration for molecular testing (syndromic PCR or NGS)