Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK; Genomic Medicine - St George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE; King's College London, Strand, London.
Department of Trauma and Orthopedics, East Cheshire NHS Trust, Macclesfield District General Hospital, Victoria Road, Macclesfield, Cheshire, SK10 3BL, UK.
Expert Rev Mol Diagn. 2022 Jun;22(6):603-624. doi: 10.1080/14737159.2021.1894929. Epub 2021 Jun 21.
Prosthetic joint infections (PJIs) can be challenging to eradicate and have high morbidity and mortality. Current microbiology culture methods can be associated with a high false-negative rate of up to 50%. Early and accurate diagnosis is crucial for effective treatment, and negative results have been linked to a greater rate of reoperation.
There has been increasing investigation of the use of next-generation sequencing (NGS) technology such as metagenomic shotgun sequencing to help identify causative organisms and decrease the uncertainty around culture-negative infections. The clinical importance of the organisms detected and their management, however, requires further study. The polymerase chain reaction (PCR) has shown promise, but in recent years multiple studies have reported similar or lower sensitivity for bacteria detection in PJIs when compared to traditional culture. Furthermore, issues such as high cost and complexity of sample preparation and data analysis are to be addressed before it can move further toward routine clinical practice.
Metagenomic NGS has shown results that inspire cautious optimism - both in culture-positive and culture-negative cases of joint infection. Refinement of technique could revolutionize the way PJIs are diagnosed, managed, and drastically improve outcomes from this currently devastating complication.
人工关节感染（PJI）难以根治，且发病率和死亡率较高。目前的微生物培养方法可能存在高达 50%的假阴性率。早期和准确的诊断对于有效治疗至关重要，阴性结果与更高的再手术率有关。
人们越来越多地研究使用下一代测序（NGS）技术，如宏基因组鸟枪法测序，以帮助确定致病生物，并减少培养阴性感染的不确定性。然而，检测到的生物的临床重要性及其管理需要进一步研究。聚合酶链反应（PCR）显示出了一定的前景，但近年来，多项研究报告称，与传统培养相比，PCR 对 PJI 中细菌的检测灵敏度相似或更低。此外，在将其进一步推向常规临床实践之前，还需要解决成本高、样本制备和数据分析复杂等问题。
宏基因组 NGS 的结果令人谨慎乐观——无论是在培养阳性还是培养阴性的关节感染病例中。该技术的改进可能会彻底改变 PJI 的诊断、管理方式，并极大地改善这种目前具有破坏性的并发症的预后。
