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Molecular sequencing technologies in the diagnosis and management of prosthetic joint infections

Zakareya Gamie1, Dileep Karthikappallil2, Emane Gamie3

  • 1Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK; Genomic Medicine - St George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE; King's College London, Strand, London.

Expert Review of Molecular Diagnostics
|March 1, 2021
PubMed
Abstract

Insights

Next-generation sequencing (NGS) shows promise for diagnosing prosthetic joint infections (PJIs), potentially improving outcomes. Further research is needed to refine techniques and address challenges before widespread clinical adoption for PJI diagnosis.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Genomics

Background:

  • Prosthetic joint infections (PJIs) present significant challenges in eradication, leading to high morbidity and mortality.
  • Traditional microbiology culture methods for PJIs exhibit a high false-negative rate (up to 50%), complicating diagnosis and treatment.
  • Accurate and early diagnosis of PJIs is critical for effective management and reducing reoperation rates.

Purpose of the Study:

  • To explore the utility of next-generation sequencing (NGS) technologies, specifically metagenomic shotgun sequencing, in identifying causative organisms in PJIs.
  • To assess the potential of NGS to reduce diagnostic uncertainty in culture-negative PJI cases.
  • To review the current status and future prospects of NGS and PCR in PJI diagnostics.

Main Methods:

  • Review of current literature on next-generation sequencing (NGS) and polymerase chain reaction (PCR) applications in prosthetic joint infections (PJIs).
  • Analysis of reported sensitivities and specificities of NGS and PCR compared to traditional culture methods.
  • Discussion of the clinical implications and management strategies for organisms detected by NGS.

Main Results:

  • Metagenomic NGS offers potential for improved pathogen detection in both culture-positive and culture-negative PJIs.
  • Polymerase chain reaction (PCR) has shown comparable or lower sensitivity than traditional cultures for PJI bacteria detection in recent studies.
  • High costs and complexity of sample preparation and data analysis remain barriers for routine clinical implementation of NGS.

Conclusions:

  • Metagenomic NGS demonstrates cautious optimism for revolutionizing PJI diagnosis and management.
  • Refinement of NGS techniques is crucial for improving outcomes in patients with prosthetic joint infections.
  • Further studies are required to establish the clinical importance and management guidelines for NGS-detected organisms in PJIs.
Keywords:
Biofilmculture-negativediagnosismetagenomicsmolecularnext-generation sequencingpcrprosthetic joint infection

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