Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
Department of Pharmacy, Mie University Hospital, Mie, Japan.
J Orthop Surg Res. 2023 Aug 16;18(1):604. doi: 10.1186/s13018-023-03973-5.
Accurate diagnosis of prosthetic joint infection (PJI) enables early and effective treatment. However, there is currently no gold standard test for microbial detection of PJI and traditional synovial fluid culture is relatively insensitive. Recently, it has been reported that sonicating fluid culture and next-generation sequencing (NGS) improve microbial detection rates. Hence, we performed a systematic review and meta-analysis to compare microbial detection rates in microbial culture methods with and without sonication versus NGS.
We systematically searched EMBASE, PubMed, Scopus, CINAHL, and Ichushi databases and other sources (previous reviews) until August 2022. We evaluated the detection rates of pathogens in NGS and microbial cultures using samples of synovial or sonicated fluid.
Of the 170 citations identified for screening, nine studies were included. Pooled analysis indicated that NGS had the highest detection rate among the microbial detection methods (NGS vs. sonicated, odds ratios [OR] 5.09, 95% confidential interval [CI] 1.67-15.50; NGS vs. synovial, OR 4.52, 95% CI 2.86-7.16). Sonicated fluid culture showed a higher detection rate than synovial fluid culture (OR 2.11, 95% CI 1.23-3.62).
NGS might be useful as a screening tool for culture-negative patients. In clinical settings, sonicated fluid culture is a practical method for diagnosing PJI.
准确诊断人工关节感染（PJI）可实现早期、有效治疗。然而，目前尚无 PJI 微生物检测的金标准，传统的滑膜液培养相对不敏感。最近，有研究报道称，超声处理液培养和下一代测序（NGS）可提高微生物检测率。因此，我们进行了系统评价和荟萃分析，以比较有和无超声处理以及 NGS 时微生物培养方法的微生物检测率。
我们系统地检索了 EMBASE、PubMed、Scopus、CINAHL 和 Ichushi 数据库以及其他来源（先前的综述），检索时间截至 2022 年 8 月。我们使用滑膜或超声处理液样本评估了 NGS 和微生物培养物中病原体的检测率。
在筛选出的 170 条引文中有 9 项研究被纳入。汇总分析表明，NGS 在微生物检测方法中具有最高的检测率（NGS 与超声处理相比，比值比 [OR] 5.09，95%置信区间 [CI] 1.67-15.50；NGS 与滑膜相比，OR 4.52，95%CI 2.86-7.16）。超声处理液培养的检测率高于滑膜液培养（OR 2.11，95%CI 1.23-3.62）。
NGS 可能是用于培养阴性患者的筛选工具。在临床环境中，超声处理液培养是诊断 PJI 的实用方法。
