Diagnostic Performance of Metagenomic Next⁃Generation Sequencing in the Diagnosis of Prosthetic Joint Infection Using Tissue Specimens

Abstract

Purpose

The purpose of this study was to evaluate the ability of metagenomic next-generation sequencing (mNGS) diagnosing prosthetic joint infection (PJI) using tissue from hip/knee rapidly and precisely, especially in patients who had received antibiotic treatment within the preceding two weeks.

Methods

From May 2020 to March 2022, 52 cases with suspected PJI were enrolled. mNGS was performed on surgical tissue samples. The sensitivity and specificity of mNGS in diagnosis was evaluated using culture in conjunction with MSIS criteria. This study also looked at how antibiotic use affected culture and mNGS efficacy.

Results

According to MSIS criteria, 31 of the 44 cases had PJI, and 13 were classified in the aseptic loosening group. Sensitivity, specificity, positive/negative predictive value (PPV/NPV), positive/negative likelihood ratio (PLR/NLR), and area under the curve (AUC) of mNGS assay were 80.6% (71.9–91.8%), 84.6 (73.7–97.9%), 92.6 (84.2–98.7%), 64.7 (58.6–74.7%), 5.241 (4.081–6.693), 0.229 (0.108–0.482) and 0.826 (0.786–0.967), respectively, with MSIS as a reference. When MSIS was used as a reference, the results of culture assay were 45.2% (40.8–51.5%), 100 (100.0–100.0%), 100 (100.0–100.0%), 43.3 (39.1–49.5%), +∞, 0.548 (0.396–0.617) and 0.726 (0.621–0.864), respectively. The AUC values for mNGS and culture were 0.826 and 0.731, respectively, and the differences were insignificant. mNGS demonstrated higher sensitivity than culture in PJI subjects who had previously received antibiotic treatment within 2 weeks (69.5% vs 23.1%, P = 0.03).

Conclusion

In our series, mNGS yield a higher sensitivity for diagnosis and pathogen detection of PJI compared to microbiological culture. Additionally, mNGS is less affected by prior antibiotic exposure.

Keywords:

• prosthetic joint infection
• metagenomic next⁃generation sequencing MSIS criteria
• antibiotic treatment

Abbreviations

PJI, Periprosthetic joint infection; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; BMI, body mass index; PCT, Procalcitonin; mNGS, metagenomic next-generation sequencing; THR, total hip arthroplasty; TKR, total hip replacement.

Ethics Approval and Consent to Participate

The study protocol was approved by the Institutional Review Board of Zhengzhou Orthopaedics Hospital (202109). This study was conducted in accordance with the declaration of Helsinki and patient data were kept confidential.

Acknowledgments

We would like to acknowledge the hard and dedicated work of all the staff that implemented the intervention and evaluation components of the study.

Disclosure

The authors declare that there are no conflicts of interest.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.