The Clinical Impact of Metagenomic Next-Generation Sequencing for the Diagnosis of Periprosthetic Joint Infection

Abstract

Background

Synovial fluid metagenomic next-generation sequencing was introduced into the diagnosis of periprosthetic joint infection (PJI) in recent years. However, the clinical impact of mNGS remains unknown. Therefore, we performed a prospective cohort study to evaluate the clinical impact of mNGS for PJI diagnosis.

Materials and Methods

Between April 2019 and April 2021, a total of 201 patients with suspected PJI were recruited in a high-volume PJI revision center. All patients underwent joint aspiration before surgeries and the obtained synovial fluids were sent to tests for the diagnosis of PJI. Based on the clinical evaluation of these patients, the patients were categorized into three groups: Group A: the mNGS reports were not acted upon. Group B: mNGS confirmed the standard diagnostic tests of PJI and generated identical clinical impact compared to standard diagnostic tests. Group C: mNGS results guided clinical therapy. Then, the concordance between synovial mNGS and cultures was analyzed. After that, multivariate regressions were performed to explore the “targeted populations” of mNGS tests.

Results

A total of 107 patients were diagnosed with PJI based on the 2014 MSIS criteria and there were 33, 123, 45 patients in the group A, B, C respectively. The predictive factors of mNGS inducing clinical impact compared to standard diagnostic tests were negative culture results (adjusted OR: 5.88), previous history of joint infection (adjusted OR: 5.97), polymicrobial PJI revealed by culture (adjusted OR: 4.39) and PJI identified by MSIS criteria (adjusted OR: 17.06).

Conclusion

When standard diagnostic tests for PJI were performed, about 22% of synovial fluid mNGS tests can change the treatment protocols built on standard diagnostic tests and affect the clinical practice. Thus, the use of synovial fluid mNGS in some “target” populations is more valuable compared to others such as patients with previous joint infection, polymicrobial PJI, and culture-negative PJI.

Evidence Level

Level I.

Keywords:

• periprosthetic joint infection
• metagenomic next-generation sequencing
• clinical impact

Abbreviations

TJA, total joint arthroplasty; PJI, periprosthetic joint infection.

Data Sharing Statement

All data and materials were in full compliance with the journal’s policy. And the data were obtained in Department of Orthopedic Surgery, The First Medical Center, Chinese PLA General Hospital. The datasets used and during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

This study was approved by the institutional review board of our hospitals (Chinese People’s Liberation Army General Hospital and PLA rocket force characteristics medical Center). Institutional review board approval was obtained prior to the commencement of this study and informed consents were obtained before revisions. And informed consent was obtained from the study participants prior to study commencement. This study was performed in accordance with the ethical standards in the 1964 Declaration of Helsinki.

Consent for Publication

We have obtained consent to publish from the participants.

Acknowledgments

The authors would like to thank Tao Deng for his participation in the data collection process of this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

National Key Research and Development Program of China (No.2020YFC2004900), General Program of China Postdoctoral Science Foundation (No.2020T130775), Youth Project of National Natural Science Foundation of China (No.82102585), and Military Medical Science and Technology Youth Training Project (No.21QNPY110).