Higher sensitivity and accuracy of synovial next-generation sequencing in comparison to culture in diagnosing periprosthetic joint infection: a systematic review and meta-analysis

Abstract

Purpose The purpose of this meta-analysis was to compare the diagnostic parameters of synovial next-generation sequencing (NGS) and cultures in diagnosing periprosthetic joint infections (PJI). Methods PubMed, Web of Science, Cochrane, and Google Scholar were searched from inception until 8 Jan 2022 for literature investigating the role of NGS in comparison to culture in the diagnosis of PJI. The studies were included if they investigated the diagnostic value of culture and NGS in diagnosing PJIs against the Musculoskeletal Infection Society (MSIS) criteria. Diagnostic parameters, such as sensitivity, specificity, positive predictive value, negative predictive value, positive-likelihood ratio, negative-likelihood ratio, accuracy, and area under the curve (AUC), were calculated for the included studies to evaluate the performance of NGS in comparison to culture in PJI diagnosis. Results The total number of the included patients was 341 from seven articles. The pooled sensitivity, specificity, and diagnostic odds ratio of NGS were 94% (95% CI 91–97%), 89% (95% CI 82–95%), and 138.5 (95% CI 49.1–390.5), respectively. NGS has positive- and negative-likelihood ratios of 7.9 (95% CI 3.99–15.6) and 0.1 (95% CI 0.0–0.1), respectively. On the other hand, the pooled sensitivity, specificity, and diagnostic odds ratio of culture were 70% (95% CI 61–79%), 94% (95% CI 88–98%), and 28.0 (95% CI 12.6–62.2), respectively. The SROC curve for NGS showed that the accuracy (AUC) was 91.9%, and that the positive and negative predictive values were 8.6 (95% CI 5.0–19.5) and 0.1 (95% CI 0.0–0.1), respectively. While, culture SROC curve demonstrated that the accuracy (AUC) was 80.5% and the positive- and negative-likelihood ratio were 12.1 (95% CI 4.5–49.6) and 0.3 (95% CI 0.2–0.4). Conclusions NGS has a potential role in diagnosing hip and knee PJIs due to its high sensitivity, specificity, and accuracy. However, the sensitivity and specificity reported by the studies varied according to the time of synovial sampling (preoperative, postoperative, or mixed).

Molecular Diagnosis of Osteoarticular Implant-Associated Infection: Available Techniques and How We Can Use Them

“…The sensitivity and specificity of NGS for PJI diagnosis vary among different studies. The meta-analysis published by Hantouly et al reported a pooled sensitivity of 94%, higher than the one obtained by culture (70%) and slightly lower specificity (89%) in comparison to culture (94%) [46]. Additionally, the accuracy was higher using NGS technology (91.9%) than culture-based methods (80.5%).…”

Impact of unplanned second debridement, antibiotics and implant retention on long‐term outcomes in knee exchange arthroplasty: Elevated risk of failure and reinfection

“…Despite the culture‐negative rate (35.7% to 34.6% in the first DAIR vs. 46.2% in the unplanned second DAIR), our study was unable to definitively discern whether persistent infection, new infection, or a combination of both were present. Modern techniques with next‐generation sequencing [ 11 ] and machine‐learning model might be helpful in the future [ 18 ]. This limitation led us to implement a time interval of 2 years after the completion of antibiotic treatment to evaluate if a subsequent PJI occurred.…”

Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the application of a new molecular testing diagnostic algorithm

“…NGS techniques demonstrated, in previous studies, very high sensitivity and specificity in microorganism detection [ 4 , 7 , 13 ]. Nevertheless, a major limitation of the use of current NGS techniques in synovial fluid analysis is represented by the high incidence of detection of multiple microorganisms in the same synovial fluid sample: few authors utilized this finding to support the multi‐bacterial etiopathogenesis of many PJI [ 8 , 18 ] while other authors [ 27 ] considered those microorganisms as native microbiome rather than pathogenic microbes. In the current study, mNGS was the main determinant for microorganism detection in only 11%: this finding confirms previous recommendations that nucleic acid amplification techniques do not represent, so far, the first‐line diagnostic technologies for microorganism detection in SA and PJI scenarios [ 8 , 18 ] but a complementary tool to conventional culture and PCR assays [ 6 , 15 ].…”