Detecting the presence of bacteria in low-volume preoperative aspirated synovial fluid by metagenomic next-generation sequencing

Abstract

Preoperative diagnosis is important for patients who need revision surgery due to PJI. Microbial culture plays an important role in PJI diagnosis, but the sensitivity of cultures is low when the sample amount is limited or when a patient is treated with antibiotics before sample collection. In this study, metagenomic next-generation sequencing (mNGS) was used to detect bacteria in preoperative puncture synovial fluid samples from patients with suspected PJI, and the preoperative and intraoperative culture results were compared to estimate its diagnostic efficiency. Methods: From July 2016 to December 2018, patients with suspected PJI who underwent prosthetic joint revision surgery were included, and the results of those who had been tested by preoperative synovial fluid culture and mNGS were obtained. The demographic characteristics, medical history, laboratory test results, culture results, and mNGS results of each patient were recorded. Then, the efficiency of preoperative synovial fluid mNGS was compared to that of synovial fluid culture for diagnosing PJI. Results: A total of 37 patients were included, and 24 patients (25 joints) were diagnosed with PJI. The sensitivity, specificity, and accuracy of preoperative synovial fluid mNGS were 92%, 91.7%, and 83.7%, respectively. The sensitivity, specificity, and accuracy of preoperative synovial fluid culture were 52%, 91.7%, and 43.7%, respectively. Conclusions: With a low volume of synovia (1 ml), mNGS can be performed with higher sensitivity and specificity compared to synovial culture. Thus, mNGS can be a useful supplemental method to improve diagnostic efficiency during the preoperative period.

Synovial fluid calprotectin performs better than synovial fluid polymerase chain reaction and interleukin-6 in the diagnosis of periprosthetic joint infection

“…Synovial polymerase chain reaction studies. Overall, 20 studies described the diagnostic accuracy of synovial fluid PCR in the detection of PJi, using the msis criteria as the standard reference test, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] with baseline characteristics of individual studies shown in table i. three studies contributed to two data points each, as these studies published data on different PCR Fig. 6 Forest plot for synovial fluid calprotectin studies.…”

High‐Throughput Metagenomics for Identification of Pathogens in the Clinical Settings

“…[ 158 ] Conventional diagnostic challenges in BJI due to the fastidious nature of the organisms, biofilm formation on implant surfaces, prior antibiotic administration, or limited sample availability, all contribute to the high rate of culture‐negative PJIs, the microbial etiology for which is challenging to diagnose. [ 159,160 ]…”

“…[ 162–164 ] mNGS should be highly recommended for the cases of culture‐negative BJI, limited sample volume obtained by joint cavity puncture, or when the patient has poor responses to empirical antibiotics therapy or debridement. [ 160,165 ]…”

Identification of pathogen(s) in infectious diseases using shotgun metagenomic sequencing and conventional culture: a comparative study

“…However, literature relevant to clinical applications has mostly focused on its partial function of rapid detection in certain infectious diseases (e.g., central nervous system infections, respiratory infections, bone and joint infections, etc. ( Fang et al, 2020 ; Huang et al, 2020 ; Wilson et al, 2019 ; Yan et al, 2020 ; Zhang et al, 2020 )). On the other hand, to comprehensively interpret and evaluate the full-function of shotgun metagenomic sequencing (including pathogen identification and ARGs prediction) remains challenging, which needs more investigation and validation.…”