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Published on: December 3, 2017
Diagnostic Role of mNGS in Polymicrobial Periprosthetic Joint Infection
Jian Mei1,2,3, Hongxin Hu1,4,2,3, Si Zhu1,2,3
1Department of Orthopaedic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
Objectives:
The purpose of this study was to explore the clinical value of metagenomic next-generation sequencing (mNGS) in the diagnosis of polymicrobial periprosthetic joint infection (PJI).
Methods:
Patients with complete data who underwent surgery at our hospital between July 2017 and January 2021 for suspected periprosthetic joint infection (PJI), according to the 2018 ICE diagnostic criteria, were enrolled, and all patients underwent microbial culture and mNGS detection, which were performed on the BGISEQ-500 platform. Microbial cultures were performed on two samples of synovial fluid, six samples of tissue, and two samples of prosthetic sonicate fluid for each patient. The mNGS was performed on 10 tissues, 64 synovial fluid samples, and 17 prosthetic sonicate fluid samples. The results of mNGS testing were based on the interpretation of mNGS results in the previous literature and the assertions of microbiologists and orthopedic surgeons. The diagnostic efficacy of mNGS in polymicrobial PJI was assessed by comparing the results of conventional microbial cultures and mNGS.
Results:
A total of 91 patients were finally enrolled in this study. The sensitivity, specificity, and accuracy of conventional culture for the diagnosis of PJI were 71.0%, 95.4%, and 76.9%, respectively. The sensitivity, specificity, and accuracy of mNGS for the diagnosis of PJI were 91.3%, 86.3%, and 90.1%, respectively. The sensitivity, specificity, and accuracy of conventional culture for the diagnosis of polymicrobial PJI were 57.1%, 100%, and 91.3%, respectively. mNGS had a sensitivity, specificity, and accuracy of 85.7%, 60.0%, and 65.2%, respectively, for the diagnosis of polymicrobial PJI.
Conclusions:
mNGS can improve the diagnosis efficiency of polymicrobial PJI, and the combination of culture and mNGS is a promising method to diagnose polymicrobial PJI.
Insights
Metagenomic next-generation sequencing (mNGS) shows potential for diagnosing polymicrobial periprosthetic joint infection (PJI). Combining mNGS with traditional culture methods offers a promising approach for improved PJI diagnosis.
Area of Science:
- Orthopedics
- Infectious Diseases
- Genomics
Background:
- Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
- Accurate diagnosis of polymicrobial PJI is challenging with conventional methods.
- Metagenomic next-generation sequencing (mNGS) offers a potential advancement in etiological diagnosis.
Purpose of the Study:
- To evaluate the clinical utility of metagenomic next-generation sequencing (mNGS) for diagnosing polymicrobial periprosthetic joint infection (PJI).
- To compare the diagnostic performance of mNGS against conventional microbial cultures for PJI.
Main Methods:
- A cohort of 91 patients with suspected PJI, diagnosed based on 2018 ICE criteria, were included.
- Both conventional microbial cultures and mNGS were performed on synovial fluid, tissue, and prosthetic sonicate fluid samples.
- Diagnostic efficacy was assessed by comparing mNGS and culture results against established criteria.
Main Results:
- mNGS demonstrated higher sensitivity (91.3%) and accuracy (90.1%) for overall PJI diagnosis compared to conventional culture (71.0% sensitivity, 76.9% accuracy).
- For polymicrobial PJI, mNGS showed 85.7% sensitivity and 65.2% accuracy, while culture had 57.1% sensitivity and 91.3% accuracy.
- Conventional culture exhibited higher specificity (95.4% for PJI, 100% for polymicrobial PJI) than mNGS (86.3% for PJI, 60.0% for polymicrobial PJI).
Conclusions:
- Metagenomic next-generation sequencing (mNGS) can enhance the diagnostic efficiency for polymicrobial periprosthetic joint infection (PJI).
- The combination of conventional culture and mNGS presents a promising strategy for improving the diagnosis of polymicrobial PJI.
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