宏基因组下一代测序在人工关节感染诊断中的有效性：系统评价和荟萃分析。
The Effectiveness of Metagenomic Next-Generation Sequencing in the Diagnosis of Prosthetic Joint Infection: A Systematic Review and Meta-Analysis.
机构信息
Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Clinical Sciences, Orthopedics, Faculty of Medicine, Lund University, Lund, Sweden.
出版信息
Front Cell Infect Microbiol. 2022 Jun 10;12:875822. doi: 10.3389/fcimb.2022.875822. eCollection 2022.
BACKGROUND
A prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasties with poor prognosis. Identifying an accurate and prompt diagnostic method is particularly important for PJI. Recently, the diagnostic value of metagenomic next-generation sequencing (mNGS) in detecting PJI has attracted much attention, while the evidence of its accuracy is quite limited. Thus, this study aimed to evaluate the accuracy of mNGS for the diagnosis of PJI.
METHODS
We summarized published studies to identify the potential diagnostic value of mNGS for PJI patients by searching online databases using keywords such as "prosthetic joint infection", "PJI", and "metagenomic sequencing". Ten of 380 studies with 955 patients in total were included. The included studies provided sufficient data for the completion of 2-by-2 tables. We calculated the sensitivity, specificity, and area under the SROC curve (AUC) to evaluate mNGS for PJI diagnosis.
RESULTS
We found that the pooled diagnostic sensitivity and specificity of mNGS for PJI were 0.93 (95% CI, 0.83 to 0.97) and 0.95 (95% CI, 0.92 to 0.97), respectively. Positive and negative likelihood ratios were 18.3 (95% CI, 10.9 to 30.6) and 0.07 (95% CI, 0.03 to 0.18), respectively. The area under the curve was 0.96 (95% CI, 0.93 to 0.97).
CONCLUSION
Metagenomic next-generation sequencing displays high accuracy in the diagnosis of PJI, especially for culture-negative cases.
背景
人工关节置换术后感染（PJI）是一种破坏性并发症，预后不良。准确、及时地诊断是非常重要的。最近，宏基因组下一代测序（mNGS）在检测 PJI 中的诊断价值引起了广泛关注，但其准确性的证据相当有限。因此，本研究旨在评估 mNGS 对 PJI 的诊断准确性。
方法
我们通过搜索在线数据库，使用“人工关节感染”、“PJI”和“宏基因组测序”等关键词，总结了已发表的研究，以确定 mNGS 对 PJI 患者的潜在诊断价值。共纳入了 380 篇研究中的 10 篇，共 955 例患者，这些研究提供了足够的数据以完成 2×2 表格的分析。我们计算了 mNGS 对 PJI 诊断的敏感性、特异性和 SROC 曲线下面积（AUC），以评估其诊断价值。
结果
我们发现，mNGS 对 PJI 的诊断敏感性和特异性的合并值分别为 0.93（95%置信区间，0.83 至 0.97）和 0.95（95%置信区间，0.92 至 0.97）。阳性和阴性似然比分别为 18.3（95%置信区间，10.9 至 30.6）和 0.07（95%置信区间，0.03 至 0.18）。曲线下面积为 0.96（95%置信区间，0.93 至 0.97）。
结论
宏基因组下一代测序在 PJI 的诊断中具有较高的准确性，特别是对培养阴性的病例。
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