Metagenomic Next-Generation Sequencing Improves the Diagnosis Efficiency of Mixed Periprosthetic Joint Infections

Zibo Zhou, Yanhua Song, Yafang Yan, Yan Zheng Department of Clinical Laboratory, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan, 450000, People’s Republic of ChinaCorrespondence: Yanhua Song, Department of Clinical Laboratory, Zhengzhou Orthopaedics Hospital, No. 58 Longhai Middle Road, Zhengzhou, Henan, 450000, People’s Republic of China, Tel +86-0371-67771576, Email [email protected]: To explore the clinical significance of metagenomic next-generation sequencing (mNGS) in the diagnosis of mixed periprosthetic joint infections (PJI).Methods: The data pertaining to patients suspected of PJI who underwent arthroplasty at our hospital between January 2020 and June 2024 were analyzed. Patients included in the study were subjected to microbial culture and mNGS analyses to evaluate the efficacy of mNGS in diagnosing mixed PJIs.Results: Among the 44 PJI patients included, 20 (45.45%) were culture-positive, and 35 (79.55%) were mNGS-positive. Compared to microbial culture, mNGS demonstrated significantly higher sensitivity, negative predictive value, and accuracy (79.55% vs 45.45%, 55.00% vs 35.14%, and 80.70% vs 57.89%, respectively; all P< 0.05). However, the specificity of mNGS was significantly lower than culture (84.62% vs 100.00%, P< 0.05). For mixed PJIs, the sensitivity of mNGS was notably higher, albeit with lower specificity and positive predictive value compared to microbial culture (72.23% vs 27.27%, 85.19% vs 100.00%, 66.67% vs 100.00%, respectively; all P< 0.05). mNGS enables more sensitive detection of co-pathogens in mixed PJI, accelerating targeted therapy and reducing inappropriate broad-spectrum therapy. While its lower specificity requires clinical integration, it clarifies complex diagnoses and streamlines stewardship for improved outcomes.Conclusion: mNGS is a promising technique for rapidly and accurately detecting co-pathogens in mixed PJI.Keywords: metagenomic next-generation sequencing, periprosthetic joint infections, mixed infection, diagnosis, microbial culture