■研究宏基因组下一代测序(mNGS)在检测先前抗生素暴露的关节感染(JI)滑液(SF)样品中病原体的诊断价值。
■从2019年1月到2022年1月,纳入了59例疑似JI病例。所有病例在样本采集前2周内均有抗生素暴露。在SF样品上进行mNGS和常规培养。根据病史和临床症状并结合MSIS标准诊断JI。诊断价值,包括灵敏度,特异性,阳性/阴性预测值(PPV/NPV),和准确性,与MNGS和培养进行了比较。
■59例中有47例确诊为JI,其余12人被诊断患有非传染性疾病。mNGS的灵敏度为68.1%,显著高于培养(25.5%,p<0.01)。与39.0%的培养物相比,mNGS的准确度在71.2%显著更高(p<0.01)。通过mNGS但未通过微生物培养检测到11株病原菌,其中包括Lugdunensis葡萄球菌,cohnii葡萄球菌,Finegoldiamagna,粪肠球菌,腐生葡萄球菌,大肠杆菌,肠沙门氏菌,铜绿假单胞菌,皮氏不动杆菌,布鲁氏菌,和柯西拉。根据32例(68.1%)患者的mNGS结果调整了抗生素治疗,包括12名(25.5%)和20名(42.6%)患者,治疗升级和改变的人,分别。所有JI患者均接受手术并接受随后的抗生素治疗。术后随访20-27个月,平均23个月,治疗成功率为89.4%。在33名病原体阳性结果的患者中,再次手术1例(3.03%),在14例mNGS和培养结果均为阴性的病例中,再次手术4例(28.6%)。
■mNGS在检测先前接受抗生素治疗的JI患者的SF样本中的病原体方面比常规培养具有优势,有可能改善临床结果。
UNASSIGNED: To investigate the diagnostic value of metagenomic next-generation sequencing (mNGS) in detecting pathogens from joint infection (JI) synovial fluid (SF) samples with previous antibiotic exposure.
UNASSIGNED: From January 2019 to January 2022, 59 cases with suspected JI were enrolled. All cases had antibiotic exposure within 2 weeks before sample collection. mNGS and conventional culture were performed on SF samples. JI was diagnosed based on history and clinical symptoms in conjunction with MSIS criteria. The diagnostic values, including sensitivity, specificity, positive/negative predictive values (PPV/NPV), and accuracy, were in comparison with mNGS and culture.
UNASSIGNED: There were 47 of the 59 cases diagnosed with JI, while the remaining 12 were diagnosed with non-infectious diseases. The sensitivity of mNGS was 68.1%, which was significantly higher than that of culture (25.5%, p<0.01). The accuracy of mNGS was significantly higher at 71.2% compared to the culture at 39.0% (p <0.01). Eleven pathogenic strains were detected by mNGS but not by microbiological culture, which included Staphylococcus lugdunensis, Staphylococcus cohnii, Finegoldia magna, Enterococcus faecalis, Staphylococcus saprophytics, Escherichia coli, Salmonella enterica, Pseudomonas aeruginosa, Acinetobacter pittii, Brucella ovis, andCoxiella burnetii. Antibiotic therapy was adjusted based on the mNGS results in 32 (68.1%) patients, including 12 (25.5%) and 20 (42.6%) patients, in whom treatment was upgraded and changed, respectively. All JI patients underwent surgery and received subsequent antibiotic therapy. They were followed up for an average of 23 months (20-27 months), and the success rate of treatment was 89.4%. Out of the 33 patients who had positive results for pathogens, reoperation was performed in 1 case (3.03%), while out of the 14 cases with negative results for both mNGS and cultures, reoperation was performed in 4 cases (28.6%).
UNASSIGNED: mNGS has advantages over conventional culture in detecting pathogens in SF samples from JI patients previously treated with antibiotics, potentially improving clinical outcomes.