The Journal of arthroplasty · 2025
Microbial Culture and Metagenomic Next-Generation Sequencing (mNGS) Results-Oriented Antibiotic Regimen (MCM-ROAR) Improve Clinical Outcomes of Periprosthetic Joint Infection.
СтатьяНазвание и аннотация: Перевод в очереди
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Fang Xinyu, Cai Yuanqing, Zhang Chaofan, Li Wenbo, Huang Zida, Zhang Wenming
Аннотация
BACKGROUND: This study aimed to assess the utility of a microbial culture and metagenomic next-generation sequencing (mNGS) results-oriented antibiotic regimen (MCM-ROAR) in the management of periprosthetic joint infection (PJI).
METHODS: Patients suspected of PJI at our center were included in the study. Synovial fluid and periprosthetic tissues were collected for microbial culture and mNGS, and the results were interpreted by a panel of PJI experts. Following surgical intervention, patients were treated with antibiotics according to the MCM-ROAR procedure recommended by the panel and received regular follow-up care. Data on medical records, infection control practices, and rates of antibiotic-related complications were documented and analyzed for comparison.
RESULTS: The study included 216 PJI cases, among which 143 underwent both microbial culture and mNGS testing. Of these, 100 cases were culture-positive, while 43 cases were culture-negative. Overall, a total of 53 (37.0%) PJI cases that underwent both microbial culture and mNGS testing modified their antibiotic regimens based on mNGS results. The overall infection control rate was approximately 86.8% (131 of 151) in culture-positive PJI cases and 81.5% (53 of 65) in culture-negative PJI cases. In culture-negative PJI cases, mNGS testing and modification of antibiotic regimens based on mNGS results significantly improved infection control rates compared with PJI cases without mNGS testing (94.4 versus 63.6%; P = 0.009), while decreasing the incidence of antibiotic-related complications (8.8 versus 36.4%; P = 0.017).
CONCLUSIONS: In conclusion, mNGS is an instructive diagnostic tool for PJI, and treating PJI with MCM-ROAR could markedly improve the clinical outcomes of PJI.
METHODS: Patients suspected of PJI at our center were included in the study. Synovial fluid and periprosthetic tissues were collected for microbial culture and mNGS, and the results were interpreted by a panel of PJI experts. Following surgical intervention, patients were treated with antibiotics according to the MCM-ROAR procedure recommended by the panel and received regular follow-up care. Data on medical records, infection control practices, and rates of antibiotic-related complications were documented and analyzed for comparison.
RESULTS: The study included 216 PJI cases, among which 143 underwent both microbial culture and mNGS testing. Of these, 100 cases were culture-positive, while 43 cases were culture-negative. Overall, a total of 53 (37.0%) PJI cases that underwent both microbial culture and mNGS testing modified their antibiotic regimens based on mNGS results. The overall infection control rate was approximately 86.8% (131 of 151) in culture-positive PJI cases and 81.5% (53 of 65) in culture-negative PJI cases. In culture-negative PJI cases, mNGS testing and modification of antibiotic regimens based on mNGS results significantly improved infection control rates compared with PJI cases without mNGS testing (94.4 versus 63.6%; P = 0.009), while decreasing the incidence of antibiotic-related complications (8.8 versus 36.4%; P = 0.017).
CONCLUSIONS: In conclusion, mNGS is an instructive diagnostic tool for PJI, and treating PJI with MCM-ROAR could markedly improve the clinical outcomes of PJI.