Metagenomic next-generation sequencing of synovial fluid demonstrates high accuracy in prosthetic joint infection diagnostics: mNGS for diagnosing PJI

Bone & Joint Research

article

Zida Huang¹  Wenbo Li¹  Gwo-Chin Lee¹  Xinyu Fang¹  Li Xing²  Bin Yang³  Jianhua Lin¹  Wenming Zhang¹ 

[1] Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University;BGI Genomics;Department of Laboratory Medicine, The First Affiliated Hospital of Fujian Medical University

关键词: Metagenomic next-generation sequencing;    Prosthetic joint infection;    Diagnosis;    Synovial fluid;   

DOI  :  10.1302/2046-3758.97.BJR-2019-0325.R2

学科分类：骨科学

来源: British Editorial Society Of Bone And Joint Surgery

【 摘 要 】

AimsThe aim of this study was to evaluate the performance of metagenomic next-generation sequencing (mNGS) in detecting pathogens from synovial fluid of prosthetic joint infection (PJI) patients.MethodsA group of 75 patients who underwent revision knee or hip arthroplasties were enrolled prospectively. Ten patients with primary arthroplasties were included as negative controls. Synovial fluid was collected for mNGS analysis. Optimal thresholds were determined to distinguish pathogens from background microbes. Synovial fluid, tissue, and sonicate fluid were obtained for culture.ResultsA total of 49 PJI and 21 noninfection patients were finally included. Of the 39 culture-positive PJI cases, mNGS results were positive in 37 patients (94.9%), and were consistent with culture results at the genus level in 32 patients (86.5%) and at the species level in 27 patients (73.0%). Metagenomic next-generation sequencing additionally identified 15 pathogens from five culture-positive and all ten culture-negative PJI cases, and even one pathogen from one noninfection patient, while yielding no positive findings in any primary arthroplasty. However, seven pathogens identified by culture were missed by mNGS. The sensitivity of mNGS for diagnosing PJI was 95.9%, which was significantly higher than that of comprehensive culture (79.6%; p = 0.014). The specificity is similar between mNGS and comprehensive culture (95.2% and 95.2%, respectively; p = 1.0).ConclusionMetagenomic next-generation sequencing can effectively identify pathogens from synovial fluid of PJI patients, and demonstrates high accuracy in diagnosing PJI.

【 授权许可】

CC BY-NC