Diagnostic Value of Next‐Generation Sequencing in Periprosthetic Joint Infection: A Systematic Review

Abstract

Next‐generation sequencing (NGS) has developed rapidly in the last decade and is emerging as a promising diagnostic tool for periprosthetic joint infection (PJI). However, its diagnostic value for PJI is still uncertain. This systematic review aimed to explore the diagnostic value of NGS for PJI and verify its accuracy for culture‐negative PJI patients. We conducted this systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. Medline, Embase, and Cochrane Library were searched to identify diagnostic technique studies evaluating the accuracy of NGS in the diagnosis of PJI. The diagnostic sensitivity, specificity, and positive and negative predictive values were estimated for each article. The detection rate of NGS for culture‐negative PJI patients or PJI patients with antibiotic administration history was also calculated. Of the 87 identified citations, nine studies met the inclusion criteria. The diagnostic sensitivities and specificities of NGS ranged from 63% to 96% and 73% to 100%, respectively. The positive and negative predictive values ranged from 71% to 100% and 74% to 95%, respectively. The detection rate of NGS for culture‐negative PJI patients in six studies was higher than 50% (range from 82% to 100%), while in three studies it was lower than 50% (range from 9% to 31%). Also, the detection rate of NGS for PJIs with antibiotic administration history ranged from 74.05% to 92.31%. In conclusion, this systematic review suggests that NGS may have the potential to be a new tool for the diagnosis of PJI and should be considered to be added to the portfolio of diagnostic procedures. Furthermore, NGS showed a favorable diagnostic accuracy for culture‐negative PJI patients or PJI patients with antibiotic administration history. However, due to the small sample sizes of studies and substantial heterogeneity among the included studies, more research is needed to confirm or disprove these findings.

Mycobacterium Avium Complex Infection of the Spine in a Patient Without Acquired Immune Deficiency Syndrome: A Case Report and Literature Review

“…Since the first application of mNGS in the diagnosis of clinical infection in 2008, 5 its development has been particularly rapid in recent years. Many studies have reported that mNGS have been widely used in orthopaedic infectious diseases 6–8 . Ma et al 9 showed that mNGS had a specificity of 75.0% and a sensitivity of 70.3% in the diagnosis of spinal infections.…”

“…Many studies have reported that mNGS have been widely used in orthopaedic infectious diseases. [6][7][8] Ma et al 9 showed that mNGS had a specificity of 75.0% and a sensitivity of 70.3% in the diagnosis of spinal infections. Astur et al 10 investigated the presence of potentially infectious bacteria in patients with disc herniation by mNGS examination.…”

Analysis of the clinical efficacy of two-stage revision surgery in the treatment of periprosthetic joint infection in the knee: A retrospective study

“…Therefore, it is important to seek effective methods to improve the positive rate of bacterial culture. Emergence of metal-artifact-free magnetic resonance imaging technology, polymerase chain reaction technology, ultrasonic pyrolysis, mass spectrometry analysis, second-generation sequencing, and other technologies[ 4 , 21 - 23 ] has made identification of pathogens relatively easy. However, with the widespread application and even abuse of antibiotics, the incidence of drug-resistant bacteria, such as MRSA, is increasing, and the treatment is difficult and requires a prolonged cycle.…”

Metagenomic next-generation sequencing in osteoarticular infections with a focus on pediatrics: current concepts and clinical applications

“…There is much more adult literature on the use of mNGS in OAI, which is very promising for the future of its use in pediatric OAI. Tang et al ( 112 ) published a recent systematic review on mNGS in PJI. They included 9 papers ( 28 , 29 , 42 , 43 , 113 , 114 , 115 , 116 , 117 ), including 541 PJI patients and 466 non‐PJI patients.…”