Yin Han, Xu Duliang, Wang Dawei
Department of Orthopaedics, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, No. 67, Dongchang Road, Liaocheng, Shandong, China.
BMC Musculoskelet Disord. 2021 Mar 6;22(1):252. doi: 10.1186/s12891-021-04116-9.
We herein compared the diagnostic value of next-generation sequencing (NGS), bacterial culture, and serological biomarkers to detect periprosthetic joint infection (PJI) after joint replacement.
According to the diagnostic criteria of the Musculoskeletal Infection Society, 35 patients who underwent joint revision surgery were divided into infection (15 cases) and non-infection (20 cases) groups, and were routinely examined preoperatively for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and D-dimer levels. All patients underwent arthrocentesis preoperatively. Synovial fluid was used for white blood cell count, white blood cell classification, bacterial culture, and NGS. Furthermore, we calculated the area under the curve (AUC) of the receiver operating characteristic curve (ROC) for ESR, CRP, PCT, IL-6, and D-dimer. Data were assessed by comparing diagnostic accuracy, sensitivity, and specificity.
Fourteen patients showed positive results by NGS and seven showed positive bacterial culture results in the infection group; further, 18 showed negative results by NGS in the non-infection group. The AUC of ESR, D-dimer, CRP, IL-6, and PCT was 0.667, 0.572, 0.827, 0.767, and 0.808, respectively. The accuracy of NGS, bacterial culture, CRP, IL-6, and PCT was 0.91, 0.74, 0.77, 0.74, and 0.83, respectively. When comparing NGS with CRP, IL-6, PCT, and bacterial culture, differences in overall test results and those in sensitivity were statistically significant, and compared with CRP, differences in specificity were also statistically significant. In comparison with IL-6, PCT, and bacterial culture, the specificity of NGS was statistically insignificant.
Our results indicated that NGS had higher accuracy and sensitivity than the bacterial culture method and commonly used serological biomarkers for diagnosing PJI.
我们在此比较了下一代测序（NGS）、细菌培养和血清学生物标志物在检测关节置换术后假体周围关节感染（PJI）方面的诊断价值。
根据肌肉骨骼感染协会的诊断标准，将35例行关节翻修手术的患者分为感染组（15例）和非感染组（20例），术前常规检测红细胞沉降率（ESR）、C反应蛋白（CRP）、降钙素原（PCT）、白细胞介素-6（IL-6）和D-二聚体水平。所有患者术前均行关节穿刺。滑膜液用于白细胞计数、白细胞分类、细菌培养和NGS检测。此外，我们计算了ESR、CRP、PCT、IL-6和D-二聚体的受试者操作特征曲线（ROC）的曲线下面积（AUC）。通过比较诊断准确性、敏感性和特异性来评估数据。
感染组中14例患者NGS检测结果为阳性，7例细菌培养结果为阳性；此外，非感染组中18例患者NGS检测结果为阴性。ESR、D-二聚体、CRP、IL-6和PCT的AUC分别为0.667、0.572、0.827、0.767和0.808。NGS、细菌培养、CRP、IL-6和PCT的准确性分别为0.91、0.74、0.77、0.74和0.83。将NGS与CRP、IL-6、PCT和细菌培养进行比较时，总体检测结果和敏感性方面的差异具有统计学意义，与CRP相比，特异性方面的差异也具有统计学意义。与IL-6、PCT和细菌培养相比，NGS的特异性差异无统计学意义。
我们的结果表明，在诊断PJI方面，NGS比细菌培养方法和常用的血清学生物标志物具有更高的准确性和敏感性。
