Department of Orthopedic Surgery, Surgical Specialty Center, Hamad Medical Corporation, Doha, Qatar.
Faculty of Medicine, University of Jordan, Amman, Jordan.
Knee Surg Sports Traumatol Arthrosc. 2023 Sep;31(9):3672-3683. doi: 10.1007/s00167-022-07196-9. Epub 2022 Oct 16.
The purpose of this meta-analysis was to compare the diagnostic parameters of synovial next-generation sequencing (NGS) and cultures in diagnosing periprosthetic joint infections (PJI).
PubMed, Web of Science, Cochrane, and Google Scholar were searched from inception until 8 Jan 2022 for literature investigating the role of NGS in comparison to culture in the diagnosis of PJI. The studies were included if they investigated the diagnostic value of culture and NGS in diagnosing PJIs against the Musculoskeletal Infection Society (MSIS) criteria. Diagnostic parameters, such as sensitivity, specificity, positive predictive value, negative predictive value, positive-likelihood ratio, negative-likelihood ratio, accuracy, and area under the curve (AUC), were calculated for the included studies to evaluate the performance of NGS in comparison to culture in PJI diagnosis.
The total number of the included patients was 341 from seven articles. The pooled sensitivity, specificity, and diagnostic odds ratio of NGS were 94% (95% CI 91-97%), 89% (95% CI 82-95%), and 138.5 (95% CI 49.1-390.5), respectively. NGS has positive- and negative-likelihood ratios of 7.9 (95% CI 3.99-15.6) and 0.1 (95% CI 0.0-0.1), respectively. On the other hand, the pooled sensitivity, specificity, and diagnostic odds ratio of culture were 70% (95% CI 61-79%), 94% (95% CI 88-98%), and 28.0 (95% CI 12.6-62.2), respectively. The SROC curve for NGS showed that the accuracy (AUC) was 91.9%, and that the positive and negative predictive values were 8.6 (95% CI 5.0-19.5) and 0.1 (95% CI 0.0-0.1), respectively. While, culture SROC curve demonstrated that the accuracy (AUC) was 80.5% and the positive- and negative-likelihood ratio were 12.1 (95% CI 4.5-49.6) and 0.3 (95% CI 0.2-0.4).
NGS has a potential role in diagnosing hip and knee PJIs due to its high sensitivity, specificity, and accuracy. However, the sensitivity and specificity reported by the studies varied according to the time of synovial sampling (preoperative, postoperative, or mixed).
本荟萃分析旨在比较关节液下一代测序（NGS）和培养物在诊断人工关节假体周围感染（PJI）中的诊断参数。
从建库至 2022 年 1 月 8 日，我们在 PubMed、Web of Science、Cochrane 和 Google Scholar 上检索了评估 NGS 与培养物在 PJI 诊断中对比作用的文献。如果研究调查了关节液培养物和 NGS 在诊断 PJI 方面与肌肉骨骼感染学会（MSIS）标准的对比价值，则纳入研究。为评估 NGS 在 PJI 诊断中的表现，我们针对纳入的研究计算了诊断参数，如敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、准确度和曲线下面积（AUC）。
纳入的 7 项研究共纳入 341 例患者。NGS 的汇总敏感度、特异度和诊断比值比分别为 94%（95% CI 91-97%）、89%（95% CI 82-95%）和 138.5（95% CI 49.1-390.5）。NGS 的阳性和阴性似然比分别为 7.9（95% CI 3.99-15.6）和 0.1（95% CI 0.0-0.1）。另一方面，培养物的汇总敏感度、特异度和诊断比值比分别为 70%（95% CI 61-79%）、94%（95% CI 88-98%）和 28.0（95% CI 12.6-62.2）。NGS 的 SROC 曲线显示其准确度（AUC）为 91.9%，阳性和阴性预测值分别为 8.6（95% CI 5.0-19.5）和 0.1（95% CI 0.0-0.1）。而培养物的 SROC 曲线表明其准确度（AUC）为 80.5%，阳性似然比为 12.1（95% CI 4.5-49.6），阴性似然比为 0.3（95% CI 0.2-0.4）。
由于 NGS 具有较高的敏感度、特异度和准确度，因此它在诊断髋关节和膝关节 PJI 方面具有潜在作用。然而，研究报告的敏感度和特异度因滑膜取样时间（术前、术后或混合）而异。
