Lin Lan, Li Jiayu, Zhang Canhong, Li Juncheng, Wu Baijian, Huang Zida, Lv Jianhua, Liu Mingzhong, Li Wenbo, Zhang Wenming, Fang Xinyu
Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Front Cell Infect Microbiol. 2025 May 9;15:1564488. doi: 10.3389/fcimb.2025.1564488. eCollection 2025.
This study aimed to identify the risk factors and microbial profiles of patients with culture-negative periprosthetic joint infection (PJI) using metagenomic next generation sequencing (mNGS) and to compare the clinical characteristics and treatment outcomes of culture-negative PJI (CN PJI) with culture-positive PJI (CP PJI).
A retrospective analysis was conducted on 223 patients who met the International Consensus Meeting criteria for PJI and underwent surgical treatment at our hospital between February 2013 and January 2023. Clinical and follow-up data, including microbiological culture results and mNGS findings, were collected. Based on culture results, patients were divided into the CP PJI and CN PJI groups. Risk factors and microbial profiles of CN PJI patients were summarized with the aid of mNGS results. Differences in clinical characteristics and treatment outcomes between the two groups were also analyzed.
Among the 223 patients, 168 were in the CP PJI group, and 55 were in the CN PJI group. Risk factors for negative cultures included polymicrobial infections, infections caused by rare pathogens, and prolonged antibiotic use prior to sampling. In the CN PJI group, over a quarter of cases involved polymicrobial infections (25.5%) or rare pathogen infections (38.2%), with sp. being the most frequently identified rare pathogen (7.2%). Compared to the CP PJI group, the CN PJI group exhibited distinctly longer hospital stays (<0.001), extended antibiotic use (=0.02), and a higher rate of antibiotic-related complications (=0.026). However, no significant difference was noted in reinfection rates between the two groups (=0.412).
CN PJI presents a unique microbial spectrum and distinct clinical therapeutic characteristics. mNGS offers a more comprehensive understanding of infecting microorganisms, particularly those often missed by conventional culture techniques. With advancements in sample collection, optimized culture methods, molecular diagnostic tools, and early targeted therapies, CN PJI may achieve clinical outcomes comparable to CP PJI.
本研究旨在使用宏基因组下一代测序（mNGS）确定培养阴性的人工关节周围感染（PJI）患者的危险因素和微生物谱，并比较培养阴性PJI（CN PJI）与培养阳性PJI（CP PJI）的临床特征和治疗结果。
对2013年2月至2023年1月期间在我院接受手术治疗且符合国际共识会议PJI标准的223例患者进行回顾性分析。收集临床和随访数据，包括微生物培养结果和mNGS结果。根据培养结果，将患者分为CP PJI组和CN PJI组。借助mNGS结果总结CN PJI患者的危险因素和微生物谱。还分析了两组之间临床特征和治疗结果的差异。
223例患者中，CP PJI组168例，CN PJI组55例。培养阴性的危险因素包括混合感染、由罕见病原体引起的感染以及采样前长期使用抗生素。在CN PJI组中，超过四分之一的病例涉及混合感染（25.5%）或罕见病原体感染（38.2%），其中 菌是最常鉴定出的罕见病原体（7.2%）。与CP PJI组相比，CN PJI组的住院时间明显更长（<0.001），抗生素使用时间延长（=0.02），抗生素相关并发症发生率更高（=0.026）。然而，两组之间的再感染率没有显著差异（=0.412）。
CN PJI呈现出独特的微生物谱和明显的临床治疗特征。mNGS能更全面地了解感染微生物，尤其是那些常被传统培养技术遗漏的微生物。随着样本采集、优化培养方法、分子诊断工具和早期靶向治疗的进展，CN PJI可能实现与CP PJI相当的临床结果。
