Iranian Journal of Pathology

Pan-PCR Diagnostic Efficacy in Comparison with Traditional Methods in Patients with Septic Arthritis

Document Type : Original Research

Authors

Erta Rajabi 1
Kousha Farhadi 1
Malihe Hassannezhad 2
Mahsa Azadbakhsh 1
Alireza Abdollahi 3
Seyed Hadi Kalantar 4
Sara Ghaderkhani 2

1 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Infectious Disease and Tropical Medicine, School of Medicine, Imam Khomeini Hospital Complex, Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Pathology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

4 Department of Orthopedics, School of Medicine, Joint Reconstruction Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

https://doi.org/10.30699/ijp.2025.2058193.3456
Abstract
Background & Objective: Septic arthritis is an emergent condition caused by an infection of the joint synovial fluid. If left untreated, it can lead to irreversible damage to the affected joint. Our study focused on providing a concise profile of the Iranian population and the diagnostic roles of synovial pan-PCR and culture.
Methods: In an observational study, we evaluated the characteristics of all patients diagnosed with septic arthritis and admitted to a teaching center hospital complex. We extracted and analyzed the study of population's demographics and laboratory values.
Results: This study included 50 patients diagnosed with septic arthritis. 56% of our study population were male, and the mean age was 50.48. There were significant associations between synovial WBC counts and positive synovial culture results. Further comparison of the two diagnostic methods revealed higher pan-PCR accuracy than synovial culture.
Conclusion: Pan-PCR may have higher diagnostic accuracy than synovial culture in hospitalized patients with septic arthritis.

Keywords

Culture
Arthritis
Infectious
Polymerase Chain Reaction

Subjects

Copyright © 2026. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The license also allows users to adapt, remix, transform, and build upon the material for any purpose, including commercial use.

1.        Sweet MC, Sheena GJ, Liu S, Fisk FE, Lynch JR, Muh SJ. Clinical Characteristics and Long-term Outcomes After Septic Arthritis of the Native Glenohumeral Joint: A 20-Year Retrospective Review. Orthopedics. 2019; 42(1):e118-e23. [DOI:10.3928/01477447-20181227-01]
2.        Goldenberg DL, Brandt KD, Cohen AS, Cathcart ES. Treatment of septic arthritis. Arthritis & Rheumatism. 1975;18(1):83-90. [DOI:10.1002/art.1780180116] [PMID]
3.        García-Arias M, Balsa A, Mola EM. Septic arthritis. Best Pract Res Clin Rheumatol. 2011;25(3):407-21. [DOI:10.1016/j.berh.2011.02.001] [PMID]
4.        Cooper C, Cawley MI. Bacterial arthritis in an English health district: a 10 year review. Ann Rheum Dis. 1986;45(6):458-63. [DOI:10.1136/ard.45.6.458] [PMID] [PMCID]
5.        Kaandorp CJE, Schaardenburg DV, Krijnen P, Habbema JDF, Van De Laar MAFJ. Risk factors for septic arthritis in patients with joint disease. Arthritis & Rheumatism. 1995;38(12):1819-25.            [DOI:10.1002/art.1780381215] [PMID]
6.        Schumacher HR, Jr. Ultrastructure of the synovial membrane. Ann Clin Lab Sci. 1975;5(6):489-98.
7.        Mitchell M, Howard B, Haller J, Sartoris DJ, Resnick D. Septic arthritis. Radiol Clin North Am. 1988;26(6): 1295-313. [DOI:10.1016/S0033-8389(22)00829-6] [PMID]
8.        Connaughton A, Childs A, Dylewski S, Sabesan VJ. Biofilm Disrupting Technology for Orthopedic Implants: What's on the Horizon? Front Med (Lausanne). 2014;1:22.           [DOI:10.3389/fmed.2014.00022] [PMID] [PMCID]
9.        Barton LL, Dunkle LM, Habib FH. Septic arthritis in childhood. A 13-year review. Am J Dis Child. 1987;141(8):898-900. [PMID]      [DOI:10.1001/archpedi.1987.04460080084034]
10.     Brischetto A, Leung G, Marshall CS, Bowen AC. A Retrospective Case-Series of Children With Bone and Joint Infection From Northern Australia. Medicine (Baltimore). 2016;95(8):e2885. [PMID] [PMCID]       [DOI:10.1097/MD.0000000000002885]
11.     Goldenberg DL, Cohen AS. Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med. 1976;60(3):369-77. [DOI:10.1016/0002-9343(76)90771-3]
12.     Schattner A, Vosti KL. Bacterial arthritis due to beta-hemolytic streptococci of serogroups A, B, C, F, and G. Analysis of 23 cases and a review of the literature. Medicine (Baltimore). 1998;77(2):122-39.          [DOI:10.1097/00005792-199803000-00004] [PMID]
13.     Balabaud L, Gaudias J, Boeri C, Jenny JY, Kehr P. Results of treatment of septic knee arthritis: a retrospective series of 40 cases. Knee Surg Sports Traumatol Arthrosc. 2007;15(4):387-92.            [DOI:10.1007/s00167-006-0224-5] [PMID]
14.     Li C, Li H, Yang X, Zhu FZ, Xu C, Trampuz A. Meta-analysis of synovial fluid polymerase chain reaction for diagnosing periprosthetic hip and knee infection. J Orthop Surg Res. 2022;17(1):3. [DOI:10.1186/s13018-021-02813-8] [PMID] [PMCID]
15.     Bonilla H, Kepley R, Pawlak J, Belian B, Raynor A, Saravolatz LD. Rapid diagnosis of septic arthritis using 16S rDNA PCR: a comparison of 3 methods. Diagn Microbiol Infect Dis. 2011;69(4):390-5. [DOI:10.1016/j.diagmicrobio.2010.11.010] [PMID]
16.     Ercanbrack CW, Rahal DA, Chauhan MZ, Jabbehdari S, Uwaydat SH. Utility of pan-bacterial and pan-fungal PCR in endophthalmitis: case report and review of the literature. J Ophthalmic Inflamm Infect. 2024 Aug 1;14(1):37. [DOI:10.1186/s12348-024-00419-9] [PMID] [PMCID]
17.     Carpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med. 2011;18(8):781-96. [DOI:10.1111/j.1553-2712.2011.01121.x] [PMID] [PMCID]
18.     Ernst AA, Weiss SJ, Tracy LA, Weiss NR. Usefulness of CRP and ESR in predicting septic joints. South Med J. 2010;103(6):522-6.    [DOI:10.1097/SMJ.0b013e3181ddd246] [PMID]
19.     Fottner A, Birkenmaier C, von Schulze Pellengahr C, Wegener B, Jansson V. Can serum procalcitonin help to differentiate between septic and nonseptic arthritis? Arthroscopy. 2008;24(2):229-33.   [DOI:10.1016/j.arthro.2007.07.029] [PMID]
20.     Li SF, Henderson J, Dickman E, Darzynkiewicz R. Laboratory tests in adults with monoarticular arthritis: can they rule out a septic joint? Acad Emerg Med. 2004;11(3):276-80. [DOI:10.1197/j.aem.2003.09.018]
21.     Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004;117(8):556-62.      [DOI:10.1016/j.amjmed.2004.06.022] [PMID]
22.     Morgenstern C, Cabric S, Perka C, Trampuz A, Renz N. Synovial fluid multiplex PCR is superior to culture for detection of low-virulent pathogens causing periprosthetic joint infection. Diagn Microbiol Infect Dis. 2018;90(2):115-9.               [DOI:10.1016/j.diagmicrobio.2017.10.016] [PMID]
Iranian Journal of Pathology
Volume 21, Issue 1
Winter 2026
Pages 93-97

  • Receive Date 20 July 2025
  • Revise Date 18 August 2025
  • Accept Date 11 September 2025

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