■近年来,滑液宏基因组下一代测序技术被引入到关节假体周围感染(PJI)的诊断中。然而,mNGS的临床影响尚不清楚.因此,我们进行了一项前瞻性队列研究,以评估mNGS对PJI诊断的临床影响.
■在2019年4月至2021年4月之间,在大批量PJI修订中心招募了201名疑似PJI患者。所有患者在手术前均进行了关节抽吸,并将获得的滑液送至测试以诊断PJI。根据对这些患者的临床评估,将患者分为三组:A组:未对mNGS报告采取行动.B组:mNGS证实了PJI的标准诊断测试,并且与标准诊断测试相比产生相同的临床影响。C组:mNGS结果指导临床治疗。然后,分析了滑膜mNGS和培养物之间的一致性。之后,进行多元回归以探索mNGS测试的“目标群体”。
■根据2014年MSIS标准,共有107例患者被诊断为PJI,A组中有33、123、45例患者,B,C分别与标准诊断测试相比,mNGS诱导临床影响的预测因素是阴性培养结果(调整后的OR:5.88),既往有关节感染史(校正OR:5.97),通过培养显示的多微生物PJI(调整后的OR:4.39)和通过MSIS标准鉴定的PJI(调整后的OR:17.06)。
■进行PJI的标准诊断测试时,约22%的滑液mNGS测试可以改变基于标准诊断测试的治疗方案,并影响临床实践.因此,在一些“目标”人群中使用滑液mNGS比其他人群更有价值,例如以前患有关节感染的患者,多微生物PJI,和文化阴性的PJI。
■一级
UNASSIGNED: Synovial fluid metagenomic next-generation sequencing was introduced into the diagnosis of periprosthetic joint infection (PJI) in recent years. However, the clinical impact of mNGS remains unknown. Therefore, we performed a prospective cohort study to evaluate the clinical impact of mNGS for PJI diagnosis.
UNASSIGNED: Between April 2019 and April 2021, a total of 201 patients with suspected PJI were recruited in a high-volume PJI revision center. All patients underwent joint aspiration before surgeries and the obtained synovial fluids were sent to tests for the diagnosis of PJI. Based on the clinical evaluation of these patients, the patients were categorized into three groups: Group A: the mNGS reports were not acted upon. Group B: mNGS confirmed the standard diagnostic tests of PJI and generated identical clinical impact compared to standard diagnostic tests. Group C: mNGS results guided clinical therapy. Then, the concordance between synovial mNGS and cultures was analyzed. After that, multivariate regressions were performed to explore the \"targeted populations\" of mNGS tests.
UNASSIGNED: A total of 107 patients were diagnosed with PJI based on the 2014 MSIS criteria and there were 33, 123, 45 patients in the group A, B, C respectively. The predictive factors of mNGS inducing clinical impact compared to standard diagnostic tests were negative culture results (adjusted OR: 5.88), previous history of joint infection (adjusted OR: 5.97), polymicrobial PJI revealed by culture (adjusted OR: 4.39) and PJI identified by MSIS criteria (adjusted OR: 17.06).
UNASSIGNED: When standard diagnostic tests for PJI were performed, about 22% of synovial fluid mNGS tests can change the treatment protocols built on standard diagnostic tests and affect the clinical practice. Thus, the use of synovial fluid mNGS in some \"target\" populations is more valuable compared to others such as patients with previous joint infection, polymicrobial PJI, and culture-negative PJI.
UNASSIGNED: Level I.