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Comparison of the Diagnostic Performance of Culture, Histopathology, and mNGS for Periprosthetic Joint Infection
Lan Wei1, Yali Yu2, Shaohua Wang3
1Zhengzhou Orthopaedic Hospital, Zhengzhou, People's Republic of China.
Background:
This study evaluated the applicability of histopathology, culture, and Metagenomic next-generation sequencing (mNGS) in diagnosing periprosthetic joint infection (PJI).
Methods:
In this prospective trial, 215 consecutive patients with suspected knee PJI were enrolled. Tissue specimens were aseptically collected and processed for histopathological analysis, culture, and mNGS. PJI diagnosis was primarily based on the 2011 MSIS criteria, with reference to the 2018 ICM criteria for improved diagnostic accuracy. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of each diagnostic method were calculated.
Results:
Among 58 patients included in the final analysis, 38 were diagnosed with PJI and 20 without PJI. The mNGS assay demonstrated a sensitivity of 63.2% (95% CI: 53.6-77.7%), specificity of 80.0% (75.7-90.1%), PPV of 85.7% (76.4-95.3%), NPV of 53.3% (44.6-61.2%), PLR of 1.84 (1.22-2.77), and NLR of 0.27 (0.10-0.40). Culture showed higher specificity at 95.0% (84.6-99.8%) and PPV at 96.5% (88.7-99.7%), with sensitivity of 68.4% (58.2-78.9%). Histopathology exhibited 52.6% sensitivity and perfect specificity (100%). The most commonly detected pathogens by both culture and mNGS were Staphylococcus aureus and coagulase-negative Staphylococci, which are frequently implicated in PJI.
Conclusion:
mNGS shows promise as a complementary tool for diagnosing PJI, especially in culture-negative or atypical cases. However, it did not outperform conventional methods in accuracy. Its limitations-including a high false-positive rate, interpretive challenges, and lack of susceptibility data-warrant cautious use. Further large-scale studies are needed to define its role in clinical decision-making.
Insights
Metagenomic next-generation sequencing (mNGS) shows potential for diagnosing periprosthetic joint infection (PJI), particularly in difficult cases. However, it did not surpass traditional methods and requires further research before widespread clinical adoption.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infection (PJI) poses a significant challenge in orthopedic surgery.
- Accurate diagnosis is crucial for effective treatment and patient outcomes.
- Evaluating novel diagnostic tools like Metagenomic next-generation sequencing (mNGS) is essential.
Purpose of the Study:
- To compare the diagnostic performance of histopathology, culture, and mNGS for periprosthetic joint infection (PJI).
- To assess the sensitivity, specificity, and predictive values of each method in a prospective patient cohort.
Main Methods:
- A prospective trial involving 215 patients with suspected knee PJI.
- Tissue specimens were analyzed using histopathology, microbial culture, and mNGS.
- Diagnostic accuracy was evaluated using established criteria (MSIS 2011, ICM 2018).
Main Results:
- Among 58 patients analyzed, mNGS showed 63.2% sensitivity and 80.0% specificity.
- Culture demonstrated higher specificity (95.0%) and positive predictive value (96.5%).
- Histopathology had 52.6% sensitivity and 100% specificity; common pathogens identified were *Staphylococcus aureus* and coagulase-negative Staphylococci.
Conclusions:
- mNGS is a promising adjunctive tool for PJI diagnosis, especially in culture-negative scenarios.
- Current evidence suggests mNGS does not outperform conventional methods in overall accuracy.
- Limitations include potential false positives and lack of antimicrobial susceptibility data, necessitating cautious interpretation and further studies.
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