Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.
Bone Joint J. 2021 Jan;103-B(1):26-31. doi: 10.1302/0301-620X.103B1.BJJ-2020-0017.R3.
Use of molecular sequencing methods in periprosthetic joint infection (PJI) diagnosis and organism identification have gained popularity. Next-generation sequencing (NGS) is a potentially powerful tool that is now commercially available. The purpose of this study was to compare the diagnostic accuracy of NGS, polymerase chain reaction (PCR), conventional culture, the Musculoskeletal Infection Society (MSIS) criteria, and the recently proposed criteria by Parvizi et al in the diagnosis of PJI.
In this retrospective study, aspirates or tissue samples were collected in 30 revision and 86 primary arthroplasties for routine diagnostic investigation for PJI and sent to the laboratory for NGS and PCR. Concordance along with statistical differences between diagnostic studies were calculated.
Using the MSIS criteria to diagnose PJI as the reference standard, the sensitivity and specificity of NGS were 60.9% and 89.9%, respectively, while culture resulted in sensitivity of 76.9% and specificity of 95.3%. PCR had a low sensitivity of 18.4%. There was no significant difference based on sample collection method (tissue swab or synovial fluid) (p = 0.760). There were 11 samples that were culture-positive and NGS-negative, of which eight met MSIS criteria for diagnosing infection.
In our series, NGS did not provide superior sensitivity or specificity results compared to culture. PCR has little utility as a standalone test for PJI diagnosis with a sensitivity of only 18.4%. Currently, several laboratory tests for PJI diagnosis should be obtained along with the overall clinical picture to help guide decision-making for PJI treatment. Cite this article: 2021;103-B(1):26-31.
在假体周围关节感染（PJI）诊断和病原体鉴定中使用分子测序方法已变得流行。下一代测序（NGS）是一种潜在的强大工具，现在已商业化。本研究的目的是比较 NGS、聚合酶链反应（PCR）、常规培养、肌肉骨骼感染学会（MSIS）标准以及 Parvizi 等人最近提出的标准在 PJI 诊断中的准确性。
在这项回顾性研究中，对 30 例翻修术和 86 例初次关节置换术的关节液或组织样本进行采集，用于常规 PJI 诊断性研究，并送往实验室进行 NGS 和 PCR。计算了诊断研究之间的一致性和统计学差异。
以 MSIS 标准诊断 PJI 为参考标准，NGS 的敏感性和特异性分别为 60.9%和 89.9%，而培养的敏感性为 76.9%，特异性为 95.3%。PCR 的敏感性较低，为 18.4%。根据样本采集方法（组织拭子或关节液），无统计学差异（p=0.760）。有 11 个培养阳性而 NGS 阴性的样本，其中 8 个符合 MSIS 感染诊断标准。
在我们的系列研究中，与培养相比，NGS 并未提供更高的敏感性或特异性结果。PCR 作为 PJI 诊断的独立检测手段，其敏感性仅为 18.4%，实用性较小。目前，应获得几种实验室检测方法来进行 PJI 诊断，并结合整体临床情况，以帮助指导 PJI 治疗决策。
