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Early and Accurate Pathogen Identification Based on mNGS: Key to Timely Therapy for Mycoplasma Prosthetic Joint

Zhenyuan Lin1,2,3, Yang Chen1,2,3, Zhenggui Yu1,2,3

  • 1Department of Orthopedics, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.

Orthopaedic Surgery
|June 4, 2025
PubMed
Summary

Invasive urinary catheterization is a key risk factor for Mycoplasma prosthetic joint infection (PJI). Metagenomic next-generation sequencing (mNGS) aids early detection, leading to successful treatment outcomes comparable to bacterial PJI.

Keywords:
MycoplasmaStaphylococcushistory of invasive urinary catheterizationmetagenomic next‐generation sequencingprosthetic joint infection

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Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Microbiology

Background:

  • Prosthetic joint infection (PJI) due to Mycoplasma is rare and poorly characterized.
  • Existing literature primarily consists of individual case reports, lacking systematic comparative analysis.

Purpose of the Study:

  • To systematically compare demographic, clinical, diagnostic, and therapeutic characteristics of Mycoplasma PJI versus conventional bacterial PJI.
  • To identify risk factors and optimize diagnostic and treatment strategies for Mycoplasma PJI.

Main Methods:

  • Retrospective case-control study analyzing 6 simplex Mycoplasma PJI, 4 mixed Mycoplasma PJI, 33 Staphylococcus aureus, and 21 Staphylococcus epidermidis PJI cases.
  • Analysis included perioperative markers, cultures, metagenomic next-generation sequencing (mNGS), urinary catheterization history, and treatment outcomes.
  • Statistical comparison using t-tests, Mann-Whitney U, chi-square, and Fisher's exact tests.

Main Results:

  • Invasive urinary catheterization history was significantly higher in Mycoplasma PJI groups compared to bacterial controls (p < 0.05).
  • Routine culture positivity was lower for Mycoplasma PJI, but mNGS detected Mycoplasma effectively.
  • Cure rates were comparable across all PJI groups (p = 1.000), with one Mycoplasma PJI case successfully treated with antibiotics alone.

Conclusions:

  • Invasive urinary catheterization is a significant risk factor for Mycoplasma PJI.
  • A multimodal diagnostic approach combining mNGS, optimized cultures, and 16S rRNA PCR enhances early Mycoplasma detection.
  • This approach improves diagnostic accuracy and guides effective therapeutic interventions for Mycoplasma PJI.