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The Role of Applying Metagenomic Next-Generation Sequencing (mNGS) in Periprosthetic Joint Infection with Sinus
Xuhui Yuan1,2,3, Qijin Wang1,2,3,4, Haiqi Ding1,2,3
1Department of Orthopaedic Surgery, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, People's Republic of China.
Background:
Diagnosing periprosthetic joint infection (PJI), especially with sinus tracts, is challenging using traditional cultures. Metagenomic next-generation sequencing (mNGS) offers a culture-independent diagnostic approach. We evaluated mNGS's role in diagnosing and guiding treatment for PJI with sinus tracts.
Methods:
This retrospective analysis included 52 PJI patients (2019-2024). An mNGS group (n=43; 18 sinus PJI, 25 non-sinus PJI) was compared to a non-mNGS control group (n=9; all sinus PJI, culture-diagnosed). We compared pathogen detection rates. For sinus PJI patients (two-stage revision), 2-year cure rates and antibiotic duration were compared between mNGS-guided and non-mNGS-guided therapy.
Results:
In sinus PJI cases (n=18), mNGS achieved significantly higher pathogen detection (88.9%, 16/18) versus culture (50.0%, 9/18) (Relative Risk [RR] 1.78; P=0.027). mNGS also detected more polymicrobial infections (38.9%, 7/18) compared to culture (5.6%, 1/18) (RR 7.00; P=0.041). For sinus PJI treatment, mNGS-guided therapy yielded a significantly higher 2-year cure rate (94.4%, 17/18) than non-mNGS therapy (55.6%, 5/9) (Absolute Risk Increase 38.9%; RR 1.70; P=0.03). Mean antibiotic duration was significantly shorter with mNGS guidance (35.62 ± 5.42 vs 47.11 ± 6.53 days; difference 11.49 days; P<0.01), with a trend towards fewer antibiotic-related complications (11.1% vs 55.6%; P=0.23).
Conclusion:
mNGS significantly improves pathogen detection, especially polymicrobial infections, in sinus tract PJI. mNGS-guided therapy for sinus PJI is associated with substantially improved cure rates and shorter antibiotic duration, highlighting its utility in guiding targeted anti-infection strategies for these complex cases.
