Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Clinical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Bone Joint J. 2021 May;103-B(5):923-930. doi: 10.1302/0301-620X.103B5.BJJ-2020-0745.R1.
As a proven and comprehensive molecular technique, metagenomic next-generation sequencing (mNGS) has shown its potential in the diagnosis of pathogens in patients with periprosthetic joint infection (PJI), using a single type of specimen. However, the optimal use of mNGS in the management of PJI has not been explored. In this study, we evaluated the diagnostic value of mNGS using three types of specimen with the aim of achieving a better choice of specimen for mNGS in these patients.
In this prospective study, 177 specimens were collected from 59 revision arthroplasties, including periprosthetic tissues, synovial fluid, and prosthetic sonicate fluid. Each specimen was divided into two, one for mNGS and one for culture. The criteria of the Musculoskeletal Infection Society were used to define PJI (40 cases) and aseptic failure (19 cases).
The sensitivity and specificity of mNGS in the diagnosis of PJI were 95% and 94.7%, respectively, for all types of specimen. The sensitivity and specificity were 65% and 100%, respectively, for periprosthetic tissues, 87.5% and 94.7%, respectively, for synovial fluid, and 92.5% and 94.7%, respectively, for prosthetic sonicate fluid. The mNGS of prosthetic sonicate fluid outperformed that for other types of specimen in the rates of detection of pathogens (84.6%), sequencing reads (> ten-fold) and the rate of genome coverage (> five-fold).
mNGS could serve as an accurate diagnostic tool in the detection of pathogens in patients with a PJI using three types of specimen. Due to its superior perfomance in identifying a pathogen, mNGS of prosthetic sonicate fluid provides the most value and may partly replace traditional tests such as bacteriological culture in these patients. Cite this article: 2021;103-B(5):923-930.
作为一种经过验证的全面的分子技术，宏基因组下一代测序（mNGS）已经显示出其在使用单一类型标本的假体周围关节感染（PJI）患者中检测病原体的潜力。然而，mNGS 在 PJI 管理中的最佳应用尚未得到探索。在这项研究中，我们使用三种类型的标本评估了 mNGS 的诊断价值，旨在为这些患者的 mNGS 选择更好的标本。
在这项前瞻性研究中，从 59 例翻修关节置换术中收集了 177 个标本，包括假体周围组织、滑膜液和假体超声液。每个标本分为两份，一份用于 mNGS，一份用于培养。采用肌肉骨骼感染学会的标准来定义 PJI（40 例）和无菌性失败（19 例）。
mNGS 对所有类型标本的 PJI 诊断的敏感性和特异性分别为 95%和 94.7%。假体周围组织的敏感性和特异性分别为 65%和 100%，滑膜液的敏感性和特异性分别为 87.5%和 94.7%，假体超声液的敏感性和特异性分别为 92.5%和 94.7%。假体超声液的 mNGS 在检测病原体（84.6%）、测序读长（> 十倍）和基因组覆盖率（> 五倍）方面优于其他类型的标本。
mNGS 可作为一种准确的诊断工具，用于检测 PJI 患者三种类型标本中的病原体。由于其在识别病原体方面的优越性能，假体超声液的 mNGS 在这些患者中可能部分替代传统的检测方法，如细菌培养。
