Fang Xinyu, Cai Yuanqing, Zhang Chaofan, Li Wenbo, Huang Zida, Zhang Wenming
Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China; Department of Orthopaedic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
J Arthroplasty. 2025 Aug 6. doi: 10.1016/j.arth.2025.07.071.
This study aimed to assess the utility of a microbial culture and metagenomic next-generation sequencing (mNGS) results-oriented antibiotic regimen (MCM-ROAR) in the management of periprosthetic joint infection (PJI).
Patients suspected of PJI at our center were included in the study. Synovial fluid and periprosthetic tissues were collected for microbial culture and mNGS, and the results were interpreted by a panel of PJI experts. Following surgical intervention, patients were treated with antibiotics according to the MCM-ROAR procedure recommended by the panel and received regular follow-up care. Data on medical records, infection control practices, and rates of antibiotic-related complications were documented and analyzed for comparison.
The study included 216 PJI cases, among which 143 underwent both microbial culture and mNGS testing. Of these, 100 cases were culture-positive, while 43 cases were culture-negative. Overall, a total of 53 (37.0%) PJI cases that underwent both microbial culture and mNGS testing modified their antibiotic regimens based on mNGS results. The overall infection control rate was approximately 86.8% (131 of 151) in culture-positive PJI cases and 81.5% (53 of 65) in culture-negative PJI cases. In culture-negative PJI cases, mNGS testing and modification of antibiotic regimens based on mNGS results significantly improved infection control rates compared with PJI cases without mNGS testing (94.4 versus 63.6%; P = 0.009), while decreasing the incidence of antibiotic-related complications (8.8 versus 36.4%; P = 0.017).
In conclusion, mNGS is an instructive diagnostic tool for PJI, and treating PJI with MCM-ROAR could markedly improve the clinical outcomes of PJI.
本研究旨在评估基于微生物培养和宏基因组下一代测序（mNGS）结果的抗生素治疗方案（MCM - ROAR）在人工关节周围感染（PJI）管理中的效用。
本研究纳入了在我们中心疑似患有PJI的患者。收集滑液和人工关节周围组织进行微生物培养和mNGS检测，结果由一组PJI专家进行解读。手术干预后，患者根据专家小组推荐的MCM - ROAR程序接受抗生素治疗，并接受定期随访。记录并分析病历、感染控制措施以及抗生素相关并发症发生率的数据以进行比较。
该研究纳入了216例PJI病例，其中143例同时进行了微生物培养和mNGS检测。在这些病例中，100例培养阳性，43例培养阴性。总体而言，共有53例（37.0%）同时进行了微生物培养和mNGS检测的PJI病例根据mNGS结果调整了抗生素治疗方案。培养阳性的PJI病例总体感染控制率约为86.8%（151例中的131例），培养阴性的PJI病例为81.5%（65例中的53例）。在培养阴性的PJI病例中，与未进行mNGS检测的PJI病例相比，mNGS检测及基于mNGS结果调整抗生素治疗方案显著提高了感染控制率（94.4%对63.6%；P = 0.009），同时降低了抗生素相关并发症的发生率（8.8%对36.4%；P = 0.017）。
总之，mNGS是PJI的一种有指导意义的诊断工具，采用MCM - ROAR治疗PJI可显著改善PJI的临床结局。
