Higher diagnostic value of next‐generation sequencing versus culture in periprosthetic joint infection: A systematic review and meta‐analysis

Abstract

BackgroundThe next‐generation sequencing (NGS) has developed rapidly in the past decade and is becoming a promising diagnostic tool for periprosthetic infection (PJI). However, its diagnostic value for PJI is still uncertain. The purpose of this systematic review and meta‐analysis was to evaluate the diagnostic value of NGS compared to culture.MethodsIn this systematic review and meta‐analysis, electronic databases including PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science and clinicaltrials.gov were searched for studies from inception to 12 November 2023. Diagnostic parameters, such as sensitivity, specificity, diagnostic odds ratio and area under the summary receiver‐operating characteristic (SROC) curve (AUC), were calculated for the included studies. A systematic review and meta‐analysis was performed.ResultsA total of 22 studies with 2461 patients were included in our study. The pooled sensitivity, specificity and diagnostic odds ratio of NGS were 87% (95% confidence interval [CI]: 83–90), 94% (95% CI: 91–96) and 111 (95% CI: 70–177), respectively. On the other hand, the pooled sensitivity, specificity and diagnostic odds ratio of culture were 63% (95% CI: 58–67), 98% (95% CI: 96–99) and 93 (95% CI: 40–212), respectively. The SROC curve for NGS and culture showed that the AUCs are 0.96 (95% CI: 0.94–0.98) and 0.82 (95% CI: 0.79–0.86), respectively.ConclusionThis systematic review and meta‐analysis found NGS had higher sensitivity and diagnostic accuracy but slightly lower specificity than culture. Based on the pooled results, we suggested NGS may have the potential to be a new tool for the diagnosis of PJI.Level of EvidenceLevel IV.

Performance of 16S rRNA Gene Next-Generation Sequencing and the Culture Method in the Detection of Bacteria in Clinical Specimens

“…Moreover, because of its capacity to detect low levels of bacterial DNA in clinical samples, 16S NGS has proved a powerful tool in the identification of difficult-to-grow bacteria. These advantages offer more accurate and comprehensive information to healthcare professionals, leading to more informed decisions and better management of patients in several settings [5][6][7], such as periprosthetic infections [8], osteomyelitis [9], and endocarditis [10]. In this regard, the latest version of the guidelines from the European Society of Cardiology recommends the use of molecular biology techniques to improve the diagnosis of culture-negative endocarditis [11].…”