Next-generation sequencing technology may help detect pathogenic bacteria of periprosthetic joint infection after arthroplasty

The next-generation sequencing technology (NGS) is an emerging microbial diagnostic technology. It can detect all nucleic acids present in the specimen at one time, including those from the host and all microorganisms. In recent years, NGS has been applied to the identification and detection of pathogens in infectious diseases, and has a high application value in blood samples. In the field of periprosthetic joint infection (PJI), NGS applications have gradually been used by everyone.

Yu Chang et al conducted a retrospective, observational, cohort study at Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China. The study has been published in ‘International wound’ journal.

Twenty-two cases of patients with joint infection after arthroplasty were selected, with 11 cases of knee and 11 cases of hip, including 8 cases of male and 14 cases of female, and an average age of 63.55 ± 13.11 years old (range from 28 to 85).

Microbiological culture results of synovial fluid and periprosthetic joint tissue and NGS results of periprosthetic joint tissue were collected. The detection rate of NGS and microbiological culture were calculated and statistically analysed by paired χ2 test.

Key findings of the study were:

• Among the 22 patients with joint infection after arthroplasty, the positive rate of NGS was 90.91% (20/22), whereas the positive rate of bacterial culture was 50.00% (11/22).

• In knee PJI patients, the positive detection rate of NGS was 81.82%, while the positive detection rate of bacterial culture was 63.64% (χ 2 = 0.9167, P = .3384).

• In patients with hip PJI, the detection rate of NGS was 100.00%, whereas the detection rate of synovial fluid bacterial culture was 36.36% (χ2 = 10.27, P = .0014).

• Paired chi-square test showed a statistically significant difference in the detection rate between the two groups (P = .0029).

• In the detection of pathogenic microorganism, NGS detected 12 kinds of bacteria, Staphylococcus aureus in 3 patients, Staphylococcus epidermidis in 5 cases, Streptococcus 1 case, Streptococcus dysgalactiae 1 case, Xanthomonas campestris 3 cases, Escherichia coli 2 cases, Bacillus cereus 2 cases, Klebsiella pneumoniae 1 case, Finegoldia magna 1 case, Corynebacterium klopensteriella in 1 case, Brucella 1 case, and Aspergillus flavus 1 case.

• Bacterial culture detected 6 kinds of bacteria, included 5 cases of Staphylococcus epidermis (including 3 cases of Methicillin-resistant coagulase-negative Staphylococcus, (MRSCoN)), 2 cases of Staphylococcus aureus (both Methicillin-resistant Staphylococcus aureus, (MRSA)), 1 case of Klebsiella pneumoniae, 1 case of Staphylococcus hominis (MRSCoN), 1 case of G+ bacillus, and 1 case of Brucella.

The authors concluded that – “Compared with traditional bacterial culture, NGS can not only improve the detection rate of pathogenic bacteria in PJI patients, detect the pathogens that are consistent with bacterial culture, but also detect a variety of other potential pathogenic bacteria. The short detection time is more conducive to the early diagnosis and timely treatment of PJI, which has certain application value. However, there were only 22 cases in this study, so further multi-centre randomised controlled prospective studies with larger samples are needed to improve the accuracy and reliability of the conclusions by combining the curative effects of PJI patients.”  

Further reading:

Application of next-generation sequencing technology in the detection of pathogenic bacteria of the periprosthetic joint infection after arthroplasty. Yu Chang, Kai Jiang et al Int Wound J. 2023; 1–8. DOI: 10.1111/iwj.14087