TY - JOUR T1 - Identifying the Pathogen by Multiplex Polymerase Chain Reaction in Bone and Joint Infections: Challenges and Future JF - The Journal of Rheumatology JO - J Rheumatol SP - 1497 LP - 1500 DO - 10.3899/jrheum.180866 VL - 45 IS - 11 AU - YVONNE ACHERMANN AU - ANNELIES S. ZINKERNAGEL Y1 - 2018/11/01 UR - http://www.jrheum.org/content/45/11/1497.abstract N2 - Diagnosis of bone and joint infections remains a challenge. In addition to the difficulty of obtaining sufficient and good clinical samples for microbiological assessment, the bacteria are often few and do not always grow. In these typical biofilm-associated infections, bacteria are embedded in a biofilm matrix, protecting them from the host’s immune system as well as from antibiotics used to treat the infection. In addition, biofilm-associated bacteria are difficult to cultivate because they are not easily recovered from the biofilm, they may be few in number, and they are often in a dormant or slow-growing state. To circumvent these difficulties encountered in recovering the bacteria in classical bacterial cultures, some possibilities that have been discussed are PCR, microcalorimetry, and concentrating the recovered fluids. Aiming to broaden the spectrum and efficiency, multiplex PCR assays have been introduced to identify the causative pathogen in bone and joint infections1,2,3,4. Because bacterial growth is not required, multiplex PCR have been thought to be the solution for diagnosis of culture-negative orthopedic infections in patients who already took antibiotics prior to the diagnostic investigation. All assays promised to have advantages of a rapid test time and to detect a large number of microorganisms, with specific primers also allowing diagnosis of polymicrobial infections. However, to date no commercial assay has found its way into routine practice, mainly because of low sensitivity or the lack of primers for pathogens not included in the multiplex primers kits.In this issue of The Journal, Morgenstern, et al5 showed results of a prospective … Address correspondence to Dr. Y. Achermann, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. E-mail: yvonne.achermann{at}usz.ch ER -