宏基因组二代测序技术在假体周围感染中寻找病原菌的应用和价值

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Abstract Objective To investigate the role and value of metagenomic sequencing technology in detection of pathogenic bacteria around prosthesis.Methods 60 patients，including 38 knee patients and 22 hip patients with prosthetic joint infection (PJI) or aseptic loosening were enrolled in the Department of Joint Surgery，Xi’an Honghui Hospital from January 2019 to January 2021.All patients were older than 18 years old.There were 42 cases in PJI group，including 16 males and 26 females with an average age of (64.33±13.03).There were 18 cases in AL group，including 6 males and 12 females with an average age of (62.50±9.78).Conventional bacterial culture and mNGS were used to detect pathogenic bacteria in joint fluid or synovial tissue samples from patients.The sensitivity，specificity，positive predictive value，negative predictive value，consistency rate，and detection time of PJI in articular fluid or synovial tissue specimens were compared between mNGS and conventional bacterial culture.Twenty PJI patients who received only negative conventional culture from January 2017 to December 2018 were further selected as the empirical antibiotic group.Twenty PJI patients who underwent mNGS testing from January 2019 to January 2021 were included in the targeted antibiotic group.The two groups were followed up for at least 6 months，and the differences between the two groups in the time of antibiotic use，the cost of antibiotics in hospital，the number of adverse reactions and recurrence cases were counted.Results Among 42 PJI patients，30 were positive in bacterial culture and 40 were positive in mNGS.Among the 18 AL patients，2 were positive for bacterial culture and 7 were positive for mNGS.A total of 12 kinds of pathogenic bacteria were detected in bacterial culture and 31 kinds of pathogenic bacteria were detected in mNGS.The sensitivity，specificity，positive predictive value，negative predictive value and consistency rate of bacterial culture group and mNGS group were 71.4%，94.4%，93.8%，33.3%，60.0% and 95.2%，61.1%，85.1%，84.6%，85.0%，respectively.The detection time of mNGS group was significantly shorter (1.87±0.39)d In culture group (5.55±0.65)d.There were statistically significant differences in sensitivity，specificity，coincidence rate and detection time between the two groups (P＜0.05).The duration of intravenous antibiotics in TA group was (10.15±1.50)d，and the antibiotic cost was (6 149.15±763.06)yuan.The duration of intravenous antibiotics in control group EA was (14.52±2.00)d，and the antibiotic treatment cost was (10 874.70±1 353.63)yuan.There were statistically significant differences in the time of intravenous antibiotic use and treatment cost between the two groups (P＜0.05). Conclusion mNGS can effectively identify the pathogenic bacteria of PJI patients.Compared with traditional culture，mNGS has higher sensitivity and consistency rate，more advantages in detection time and antibiotic cost，higher diagnostic efficiency in the diagnosis of PJI，and can provide powerful clinical guidance in the diagnosis and treatment of PJI.

Key words： metagenomic sequencing prosthetic joint infection aseptic loosening revision pathogenic bacteria

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	Articles by authors
	Dong Wenchao 1
	Zan Qiang 2
	Ma Jianbing 3
	Qing Zhong 3
	Zhi Liqiang 3*

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Dong Wenchao 1,Zan Qiang 2,Ma Jianbing 3, et al. Application and Value of Metagenomic Sequencing Technology in Searching Pathogenic Bacteria in Periprosthetic Infection[J]. sygkzz, 2022, 28(1): 30-35.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2022/V28/I1/30

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