Medical School of Chinese PLA, Beijing, People's Republic of China.
Department of Orthopedic Surgery, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, People's Republic of China.
BMC Infect Dis. 2023 Jun 22;23(1):423. doi: 10.1186/s12879-023-08390-x.
Periprosthetic joint infection (PJI) is one of the most serious complications after total joint arthroplasty (TJA) but the characterization of the periprosthetic environment microbiome after TJA remains unknown. Here, we performed a prospective study based on metagenomic next-generation sequencing to explore the periprosthetic microbiota in patients with suspected PJI.
We recruited 28 patients with culture-positive PJI, 14 patients with culture-negative PJI, and 35 patients without PJI, which was followed by joint aspiration, untargeted metagenomic next-generation sequencing (mNGS), and bioinformatics analysis. Our results showed that the periprosthetic environment microbiome was significantly different between the PJI group and the non-PJI group. Then, we built a "typing system" for the periprosthetic microbiota based on the RandomForest Model. After that, the 'typing system' was verified externally.
We found the periprosthetic microbiota can be classified into four types generally: "Staphylococcus type," "Pseudomonas type," "Escherichia type," and "Cutibacterium type." Importantly, these four types of microbiotas had different clinical signatures, and the patients with the former two microbiota types showed obvious inflammatory responses compared to the latter ones. Based on the 2014 Musculoskeletal Infection Society (MSIS) criteria, clinical PJI was more likely to be confirmed when the former two types were encountered. In addition, the Staphylococcus spp. with compositional changes were correlated with C-reactive protein levels, the erythrocyte sedimentation rate, and the synovial fluid white blood cell count and granulocyte percentage.
Our study shed light on the characterization of the periprosthetic environment microbiome in patients after TJA. Based on the RandomForest model, we established a basic "typing system" for the microbiota in the periprosthetic environment. This work can provide a reference for future studies about the characterization of periprosthetic microbiota in periprosthetic joint infection patients.
假体周围关节感染（PJI）是人工关节置换术后（TJA）最严重的并发症之一，但 TJA 后假体周围环境微生物组的特征仍不清楚。在这里，我们进行了一项基于宏基因组下一代测序的前瞻性研究，以探索疑似 PJI 患者的假体周围微生物群。
我们招募了 28 例培养阳性 PJI 患者、14 例培养阴性 PJI 患者和 35 例无 PJI 患者，随后进行关节抽吸、非靶向宏基因组下一代测序（mNGS）和生物信息学分析。我们的结果表明，PJI 组和非 PJI 组之间假体周围环境微生物组有显著差异。然后，我们基于随机森林模型构建了假体周围微生物组的“分型系统”。之后，对外验证了该“分型系统”。
我们发现假体周围微生物组通常可分为四种类型：“葡萄球菌型”、“假单胞菌型”、“大肠埃希菌型”和“棒状杆菌型”。重要的是，这四种微生物群具有不同的临床特征，与后两种类型相比，前两种类型的患者表现出明显的炎症反应。根据 2014 年肌肉骨骼感染协会（MSIS）标准，当遇到前两种类型时，更有可能确认临床 PJI。此外，组成变化的葡萄球菌与 C 反应蛋白水平、红细胞沉降率以及关节滑液白细胞计数和粒细胞百分比相关。
本研究阐明了 TJA 后患者假体周围环境微生物组的特征。我们基于随机森林模型建立了假体周围环境微生物的基本“分型系统”。这项工作可为假体周围关节感染患者假体周围微生物组特征的未来研究提供参考。
