Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China.
Int Wound J. 2023 Apr;20(4):961-970. doi: 10.1111/iwj.13943. Epub 2022 Aug 29.
The diagnostic value of next-generation sequencing (NGS) of blood samples from patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA) was evaluated by comparing it with drainage fluid NGS and bacterial culture. The study was designed as a retrospective diagnostic test. Thirty-six infected patients were diagnosed with PJI according to the Musculoskeletal Infection Society (MSIS) criteria and 57 volunteers were included in our study. NGS and bacterial culture were chosen to detect PJI after THA. Blood samples and drainage fluid were collected for NGS, and the drainage fluid, which was collected at the same time as the NGS drainage fluid sample, was used for bacterial culture. The primary outcomes of interest were sensitivity, specificity, and accuracy. In the infection group, 31 patients showed positive results by blood sample NGS, 33 patients showed positive results by drainage fluid NGS, and 17 patients showed positive bacterial culture results. In the control group, the results of 2 blood sample NGS, 16 drainage fluid NGS, and 3 bacterial cultures were positive. The sensitivity, specificity, and accuracy of the blood sample were 0.86, 0.96, and 0.92, respectively. The sensitivity, specificity, and accuracy of the drainage fluid samples were 0.92, 0.72, and 0.80, respectively. The sensitivity, specificity, and accuracy of bacterial culture were 0.47, 0.95, and 0.79, respectively. The study demonstrated that both the sensitivity and specificity of NGS were higher than those of bacterial culture, regardless of the kind of sample. Compared with drainage fluid NGS, the sensitivity of blood sample NGS was slightly lower (0.86 vs 0.92), but blood sample NGS showed higher specificity (0.96 vs 0.72). In total, the diagnostic value of blood sample NGS was superior to that of drainage fluid NGS and bacterial culture. The majority of infected patients could be identified by blood sample NGS. Moreover, because of its high specificity, blood sample NGS can not only detect infectious bacteria but also distinguish infectious from non-infectious bacteria, which is dramatically different from using drainage fluid NGS.
我们通过比较血液样本下一代测序（NGS）与引流液 NGS 和细菌培养在全髋关节置换术后假体周围关节感染（PJI）患者中的诊断价值，来评估血液样本 NGS 的诊断价值。该研究设计为回顾性诊断测试。根据肌肉骨骼感染协会（MSIS）标准，36 例感染患者被诊断为 PJI，57 名志愿者纳入我们的研究。我们选择 NGS 和细菌培养来检测全髋关节置换术后的 PJI。采集血液样本和引流液进行 NGS，同时采集引流液样本进行细菌培养。主要观察指标是敏感性、特异性和准确性。在感染组中，31 例患者血液样本 NGS 阳性，33 例患者引流液 NGS 阳性，17 例患者细菌培养阳性。在对照组中，2 例血液样本 NGS、16 例引流液 NGS 和 3 例细菌培养阳性。血液样本的敏感性、特异性和准确性分别为 0.86、0.96 和 0.92。引流液样本的敏感性、特异性和准确性分别为 0.92、0.72 和 0.80。细菌培养的敏感性、特异性和准确性分别为 0.47、0.95 和 0.79。研究表明，无论哪种样本，NGS 的敏感性和特异性均高于细菌培养。与引流液 NGS 相比，血液样本 NGS 的敏感性略低（0.86 对 0.92），但血液样本 NGS 的特异性更高（0.96 对 0.72）。总体而言，血液样本 NGS 的诊断价值优于引流液 NGS 和细菌培养。大多数感染患者可通过血液样本 NGS 识别。此外，由于其特异性高，血液样本 NGS 不仅可以检测感染性细菌，还可以区分感染性和非感染性细菌，这与使用引流液 NGS 有显著不同。
