The following is a summary of “Clinical applications of metagenomic next-generation sequencing in the identification of pathogens in periprosthetic joint infections: a retrospective study,” published in the May 2024 issue of Rheumatology by Shi et al.
This retrospective study aimed to assess the utility of metagenomic next-generation sequencing (mNGS) technology in identifying pathogens associated with periprosthetic joint infection (PJI).
Over a period spanning April 2020 to July 2023, a cohort of 65 patients suspected of PJI was retrospectively analyzed and classified into PJI (46 patients) and non-PJI (19 patients) groups according to the 2018 International Consensus Meeting criteria. Comprehensive clinical data were collected, and conventional bacterial culture and mNGS were employed. Comparative analysis evaluated the diagnostic performance of these methods.
mNGS demonstrated robust diagnostic metrics with a sensitivity of 89.13%, specificity of 94.74%, positive predictive value of 97.62%, negative predictive value of 78.26%, and overall diagnostic accuracy of 90.77%. Compared to microbial culture, mNGS exhibited superior sensitivity while maintaining comparable specificity. Across the cohort, mNGS successfully identified 48 pathogens, predominantly Coagulase-negative staphylococci, Streptococci, Staphylococcus aureus, and Cutibacterium acnes.
Notably, mNGS detected 17 potential pathogens in 14 culture-negative PJI cases, including uncommon agents like Cutibacterium acnes, Granulicatella adiacens, Mycobacterium tuberculosis complex, and Coxiella burnetii, which are typically missed by standard culture methods. However, mNGS failed to detect the pathogen in 4 culture-positive PJI cases, underscoring its limitations. Alignment analysis between mNGS and culture results revealed concordance at the genus level in 6 patients and at the species level in 18 patients. Additionally, the study identified a significantly higher prevalence of Staphylococcus aureus in the sinus tract group (45.45%) compared to the non-sinus tract group (14.29%), suggesting an association of this pathogen with sinus formation in PJI (P = 0.03). Moreover, there was no notable disparity in the occurrence of polymicrobial infections between the sinus tract (27.27%) and non-sinus tract (33.33%) groups (P = 0.37).
Metagenomic next-generation sequencing emerges as a valuable adjunct to conventional culture methods, enhancing diagnostic accuracy through improved pathogen detection strategies. Its ability to identify a broad spectrum of pathogens, including rare and difficult-to-culture organisms, underscores its potential to refine therapeutic approaches and patient outcomes in managing periprosthetic joint infections.
Source: josr-online.biomedcentral.com/articles/10.1186/s13018-024-04745-5