The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Tel Aviv University, Tel Aviv, Israel.
J Bone Joint Surg Am. 2018 Jan 17;100(2):147-154. doi: 10.2106/JBJS.17.00434.
Next-generation sequencing is a well-established technique for sequencing of DNA and has recently gained attention in many fields of medicine. Our aim was to evaluate the accuracy of next-generation sequencing in identifying the causative organism(s) in patients with periprosthetic joint infection.
In this prospective study, samples were collected from 65 revision arthroplasties (39 knees and 26 hips) and 17 primary arthroplasties (9 hips and 8 knees). Synovial fluid, deep tissue, and swabs were obtained at the time of the surgical procedure and were shipped to the laboratory for next-generation sequencing. Deep-tissue specimens were also sent to the institutional laboratory for culture. Sensitivity and specificity were calculated for next-generation sequencing, using the Musculoskeletal Infection Society (MSIS) definition of periprosthetic joint infection as the standard.
In 28 revisions, the cases were considered to be infected; cultures were positive in 17 cases (60.7% [95% confidence interval (CI), 40.6% to 78.5%]), and next-generation sequencing was positive in 25 cases (89.3% [95% CI, 71.8% to 97.7%]), with concordance between next-generation sequencing and culture in 15 cases. Among the 11 cases of culture-negative periprosthetic joint infection, next-generation sequencing was able to identify an organism in 9 cases (81.8% [95% CI, 48.2% to 97.7%]). Next-generation sequencing identified microbes in 9 (25.0% [95% CI, 12.1% to 42.2%]) of 36 aseptic revisions with negative cultures and in 6 (35.3% [95% CI, 14.2% to 61.7%]) of 17 primary total joint arthroplasties. Next-generation sequencing detected several organisms in most positive samples. However, in the majority of patients who were infected, 1 or 2 organisms were dominant.
Next-generation sequencing may be a useful adjunct in identification of the causative organism(s) in culture-negative periprosthetic joint infection. Our findings suggest that some cases of monomicrobial periprosthetic joint infection may have additional organisms that escape detection when culture is used. Further study is required to determine the clinical implications of isolated organisms in samples from patients who are not thought to be infected.
Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
下一代测序技术是一种成熟的 DNA 测序技术，最近在医学的许多领域受到关注。我们的目的是评估下一代测序技术在识别假体周围关节感染患者的病原体方面的准确性。
在这项前瞻性研究中，从 65 例翻修关节置换术（39 例膝关节和 26 例髋关节）和 17 例初次关节置换术（9 例髋关节和 8 例膝关节）中采集样本。在手术时采集滑液、深部组织和拭子，并运往实验室进行下一代测序。深部组织标本也送往机构实验室进行培养。使用 Musculoskeletal Infection Society（MSIS）假体周围关节感染定义作为标准，计算下一代测序的灵敏度和特异性。
在 28 例翻修术中，病例被认为是感染的；17 例（60.7%[95%置信区间（CI），40.6%至 78.5%]）培养阳性，25 例（89.3%[95%CI，71.8%至 97.7%]）下一代测序阳性，15 例培养和下一代测序结果一致。在 11 例培养阴性的假体周围关节感染病例中，下一代测序能够鉴定出 9 例（81.8%[95%CI，48.2%至 97.7%]）病原体。下一代测序在 9 例（25.0%[95%CI，12.1%至 42.2%]）无菌翻修术的阴性培养和 6 例（35.3%[95%CI，14.2%至 61.7%]）初次全关节置换术的阴性培养中鉴定出微生物。下一代测序在大多数阳性样本中检测到多种微生物。然而，在大多数感染患者中，1 种或 2 种病原体占主导地位。
下一代测序技术可能有助于鉴定培养阴性的假体周围关节感染的病原体。我们的发现表明，当使用培养时，一些单微生物假体周围关节感染的病例可能有其他逃避检测的病原体。需要进一步研究以确定在未感染患者的样本中分离出的孤立病原体的临床意义。
诊断水平 I. 请参阅作者说明，以获取完整的证据水平描述。
