Targeted next generation sequencing for elbow periprosthetic joint infection diagnosis

Area of Science:

• Microbiology
• Genomics
• Orthopedic Surgery

Background:

• Periprosthetic joint infection (PJI) is a serious complication following total elbow arthroplasty.
• Accurate diagnosis of PJI is crucial for effective treatment and patient outcomes.
• Traditional diagnostic methods, such as sonicate fluid culture, have limitations in sensitivity.

Purpose of the Study:

• To compare the diagnostic performance of 16S ribosomal RNA (rRNA) gene PCR followed by next-generation sequencing (NGS) with sonicate fluid culture for PJI diagnosis.
• To evaluate the sensitivity, specificity, and predictive values of targeted NGS versus culture in identifying PJI in revision total elbow arthroplasty cases.

Main Methods:

• Retrospective analysis of sonicate fluid samples from patients undergoing revision total elbow arthroplasty between 2007 and 2019.
• 16S rRNA gene PCR amplification (V1-V3 region) followed by Illumina MiSeq NGS.
• Comparison of NGS results with sonicate fluid culture using McNemar's test.

Main Results:

• Targeted NGS demonstrated a higher sensitivity (85%) compared to culture (77%) for PJI diagnosis (P = 0.045).
• Specificity was comparable, with NGS at 98% and culture at 100%.
• Positive and negative predictive values for NGS were 98% and 89%, respectively, versus 100% and 84% for culture.

Conclusions:

• 16S rRNA gene-based targeted metagenomic analysis of sonicate fluid is a more sensitive diagnostic method for PJI than conventional culture.
• Targeted NGS offers a valuable adjunctive or alternative approach for PJI diagnosis in challenging cases.
• Further research may explore the integration of NGS into routine PJI diagnostic protocols.