Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Sep;31(9):3672-3683.
doi: 10.1007/s00167-022-07196-9. Epub 2022 Oct 16.

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

Ashraf T Hantouly  1 , Osama Alzobi  1 , Ahmad A Toubasi  2 , Bashir Zikria  3 , Mohammed Al Ateeq Al Dosari  1 , Ghalib Ahmed  4
Affiliations
Meta-Analysis

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

Ashraf T Hantouly et al. Knee Surg Sports Traumatol Arthrosc. 2023 Sep.

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).

Keywords: Arthroplasty; Culture; Diagnosis; Next-generation sequencing; Periprosthetic joint infection.

PubMed Disclaimer

Conflict of interest statement

The authors have no financial or proprietary interests in any material discussed in this article. All authors declared no conflict of interest.

Figures

Fig. 1
Fig. 1
Search strategy flowchart
Fig. 2
Fig. 2
Quality assessment of the included studies using QUADAS-2 tool criteria
Fig. 3
Fig. 3
Sensitivity and specificity of next-generation sequencing and culture
Fig. 4
Fig. 4
Positive-likelihood ratio, negative-likelihood ratio, and odds ratio of next-generation sequencing and culture
Fig. 5
Fig. 5
Summary of next-generation sequencing and culture receiver-operating characteristic (SROC) curves
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Avila A, Acuña AJ, Do MT, Samuel LT, Kamath AF. Intra-articular injection receipt within 3 months prior to primary total knee arthroplasty is associated with increased periprosthetic joint infection risk. Knee Surg Sports Traumatol Arthrosc. 2022 doi: 10.1007/s00167-022-06942-3. - DOI - PubMed
    1. Bukowska-Ośko I, Perlejewski K, Nakamura S, et al. Sensitivity of next-generation sequencing metagenomic analysis for detection of RNA and DNA viruses in cerebrospinal fluid: the confounding effect of background contamination. respiratory treatment and prevention. Adv Exp Med Biol. 2016 doi: 10.1007/5584_2016_42. - DOI - PubMed
    1. Cai Y, Fang X, Chen Y, Huang Z, Zhang C, Li W, Yang B, Zhang W. Metagenomic next generation sequencing improves diagnosis of prosthetic joint infection by detecting the presence of bacteria in periprosthetic tissues. Int J Infect Dis. 2020;96:573–578. doi: 10.1016/j.ijid.2020.05.125. - DOI - PubMed
    1. Fang X, Cai Y, Shi T, Huang Z, Zhang C, Li W, Zhang C, Yang B, Zhang W, Guan Z. Detecting the presence of bacteria in low-volume preoperative aspirated synovial fluid by metagenomic next-generation sequencing. Int J Infect Dis. 2020;99:108–116. doi: 10.1016/j.ijid.2020.07.039. - DOI - PubMed
    1. Goswami K, Clarkson S, Phillips CD, Dennis DA, Klatt BA, O'Malley MJ, et al. An enhanced understanding of culture-negative periprosthetic joint infection with next-generation sequencing: a multicenter study. J Bone Joint Surg Am. 2022 doi: 10.2106/jbjs.21.01061. - DOI - PubMed

MeSH terms