Poor Agreement Between Next-Generation DNA Sequencing and Bacterial Cultures in Orthopaedic Trauma Procedures

Area of Science:

• Orthopaedic surgery
• Microbiology
• Molecular diagnostics

Background:

• Next-generation sequencing (NGS) offers higher bacterial detection accuracy than traditional culture methods.
• The clinical significance of NGS findings in orthopaedic trauma is not yet established.
• Comparing NGS and culture is crucial for evaluating NGS's role in this patient population.

Purpose of the Study:

• To compare bacterial culture and NGS results in orthopaedic trauma patients.
• To characterize the potential utility of NGS in this clinical setting.

Main Methods:

• Prospective cohort study at an academic level-I trauma center.
• Enrolled patients undergoing treatment for acute closed fractures, implant removal, or fracture nonunion.
• Collected surgical site tissue for both bacterial culture and NGS analysis.

Main Results:

• NGS detected bacteria in 24% of samples, significantly higher than culture (8.1%; p = 0.001).
• Agreement between NGS and culture was low (Cohen kappa = 0.051), indicating slight concordance.
• No significant difference in NGS positivity was observed across the different patient groups.

Conclusions:

• NGS identifies bacterial presence more frequently than culture but shows limited agreement.
• Increased NGS detection may reflect biofilms or nonpathogenic colonization, not necessarily active infection.
• NGS should not currently replace or supplement conventional culture in orthopaedic trauma cases with low suspicion of infection.