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

被引：3
作者：
Li, Hao [1 ,2 ]
Niu, Erlong [3 ]
Fu, Jun [2 ]
Huang, Yinghao [4 ]
Gao, Yang [2 ]
Chen, Jiying [5 ]
Chai, Wei [5 ]
机构：
[1] Chinese Peoples Liberat Army Gen Hosp, Med Sch Chinese PLA, Beijing 100853, Peoples R China
[2] Chinese Peoples Liberat Army Gen Hosp, Dept Orthoped, Beijing, Peoples R China
[3] 305 Hosp PLA, Dept Orthoped, Beijing, Peoples R China
[4] Beijing Jiaotong Univ, Sch Comp & Informat Technol, Beijing, Peoples R China
[5] Chinese Peoples Liberat Army Gen Hosp, Dept Orthoped, 28 Fuxing Rd, Beijing 100000, Peoples R China
来源：
INFECTION AND DRUG RESISTANCE | 2023年 / 16卷
基金：
中国国家自然科学基金; 中国博士后科学基金;
关键词：
periprosthetic joint infection; metagenomic next-generation sequencing; clinical impact; FLUID; HIP;
D O I：
10.2147/IDR.S420325
中图分类号：
R51 [传染病];
学科分类号：
100401 ;
摘要：
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.
引用
收藏
页码：6521 / 6533
页数：13
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