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

Hao Li; Erlong Niu; Jun Fu; Yinghao Huang; Yang Gao; Wei Chai; Jiying Chen

doi:10.2147/IDR.S420325

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

Infect Drug Resist. 2023 Oct 2:16:6521-6533. doi: 10.2147/IDR.S420325. eCollection 2023.

Authors

Hao Li^{1

2}, Erlong Niu³, Jun Fu², Yinghao Huang⁴, Yang Gao², Wei Chai^#², Jiying Chen^#²

Affiliations

¹ Medical School of Chinese PLA, Chinese PLA General Hospital, Beijing, People's Republic of China.
² Department of Orthopedic, Chinese PLA General Hospital, Beijing, People's Republic of China.
³ Department of Orthopedics, 305 Hospital of PLA, Beijing, People's Republic of China.
⁴ School of Computer and Information Technology, Beijing Jiaotong University, Beijing, People's Republic of China.

^# Contributed equally.

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: clinical impact; metagenomic next-generation sequencing; periprosthetic joint infection.

Publication types

Case Reports
Clinical Trial

Grants and 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).