Zhou Zibo, Song Yanhua, Yan Yafang, Zheng Yan
Department of Clinical Laboratory, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan, 450000, People's Republic of China.
Infect Drug Resist. 2025 Apr 29;18:2165-2174. doi: 10.2147/IDR.S516650. eCollection 2025.
To explore the clinical significance of metagenomic next-generation sequencing (mNGS) in the diagnosis of mixed periprosthetic joint infections (PJI).
The data pertaining to patients suspected of PJI who underwent arthroplasty at our hospital between January 2020 and June 2024 were analyzed. Patients included in the study were subjected to microbial culture and mNGS analyses to evaluate the efficacy of mNGS in diagnosing mixed PJIs.
Among the 44 PJI patients included, 20 (45.45%) were culture-positive, and 35 (79.55%) were mNGS-positive. Compared to microbial culture, mNGS demonstrated significantly higher sensitivity, negative predictive value, and accuracy (79.55% vs 45.45%, 55.00% vs 35.14%, and 80.70% vs 57.89%, respectively; all P<0.05). However, the specificity of mNGS was significantly lower than culture (84.62% vs 100.00%, P<0.05). For mixed PJIs, the sensitivity of mNGS was notably higher, albeit with lower specificity and positive predictive value compared to microbial culture (72.23% vs 27.27%, 85.19% vs 100.00%, 66.67% vs 100.00%, respectively; all P<0.05). mNGS enables more sensitive detection of co-pathogens in mixed PJI, accelerating targeted therapy and reducing inappropriate broad-spectrum therapy. While its lower specificity requires clinical integration, it clarifies complex diagnoses and streamlines stewardship for improved outcomes.
mNGS is a promising technique for rapidly and accurately detecting co-pathogens in mixed PJI.
探讨宏基因组下一代测序（mNGS）在诊断混合性人工关节感染（PJI）中的临床意义。
分析2020年1月至2024年6月在我院接受关节置换术的疑似PJI患者的数据。纳入研究的患者接受微生物培养和mNGS分析，以评估mNGS在诊断混合性PJI中的效果。
在纳入的44例PJI患者中，20例（45.45%）培养阳性，35例（79.55%）mNGS阳性。与微生物培养相比，mNGS的敏感性、阴性预测值和准确性显著更高（分别为79.55%对45.45%、55.00%对35.14%、80.70%对57.89%；均P<0.05）。然而，mNGS的特异性显著低于培养（84.62%对100.00%，P<0.05）。对于混合性PJI，mNGS的敏感性明显更高，尽管与微生物培养相比特异性和阳性预测值较低（分别为72.23%对27.27%、85.19%对100.00%、66.67%对100.00%；均P<0.05）。mNGS能够更敏感地检测混合性PJI中的共病原体，加速靶向治疗并减少不适当的广谱治疗。虽然其较低的特异性需要临床综合判断，但它有助于明确复杂诊断并优化管理以改善治疗结果。
mNGS是一种快速准确检测混合性PJI中共病原体的有前景的技术。
