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Meta-Analysis
. 2023 Aug 16;18(1):604.
doi: 10.1186/s13018-023-03973-5.

Comparison of microbial detection rates in microbial culture methods versus next-generation sequencing in patients with prosthetic joint infection: a systematic review and meta-analysis

Hideo Kato  1   2   3 , Mao Hagihara  1   4 , Nobuhiro Asai  1 , Takumi Umemura  1 , Jun Hirai  1 , Yuka Yamagishi  1 , Takuya Iwamoto  2   3 , Hiroshige Mikamo  5
Affiliations
Meta-Analysis

Comparison of microbial detection rates in microbial culture methods versus next-generation sequencing in patients with prosthetic joint infection: a systematic review and meta-analysis

Hideo Kato et al. J Orthop Surg Res. .

Abstract

Background: Accurate diagnosis of prosthetic joint infection (PJI) enables early and effective treatment. However, there is currently no gold standard test for microbial detection of PJI and traditional synovial fluid culture is relatively insensitive. Recently, it has been reported that sonicating fluid culture and next-generation sequencing (NGS) improve microbial detection rates. Hence, we performed a systematic review and meta-analysis to compare microbial detection rates in microbial culture methods with and without sonication versus NGS.

Methods: We systematically searched EMBASE, PubMed, Scopus, CINAHL, and Ichushi databases and other sources (previous reviews) until August 2022. We evaluated the detection rates of pathogens in NGS and microbial cultures using samples of synovial or sonicated fluid.

Results: Of the 170 citations identified for screening, nine studies were included. Pooled analysis indicated that NGS had the highest detection rate among the microbial detection methods (NGS vs. sonicated, odds ratios [OR] 5.09, 95% confidential interval [CI] 1.67-15.50; NGS vs. synovial, OR 4.52, 95% CI 2.86-7.16). Sonicated fluid culture showed a higher detection rate than synovial fluid culture (OR 2.11, 95% CI 1.23-3.62).

Conclusion: NGS might be useful as a screening tool for culture-negative patients. In clinical settings, sonicated fluid culture is a practical method for diagnosing PJI.

Keywords: Culture; Meta-analysis; Next-generation sequencing; Prosthetic joint infection.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of the selection of eligible studies
Fig. 2
Fig. 2
Forest plots of odds ratios for microbial detection rates in sonicated fluid culture versus NGS. a NGS of sonicated and synovial fluids. b NGS of sonicated fluid. CI confidential interval, M–H Mantel–Haenszel, NGS next-generation sequencing
Fig. 3
Fig. 3
Forest plots of odds ratios for microbial detection rates in sonicate versus synovial fluid cultures. CI confidential interval, M–H Mantel–Haenszel
Fig. 4
Fig. 4
Forest plots of odds ratios for microbial detection rates in NGS versus synovial fluid culture. a NGS of sonicated and synovial fluids. b NGS of synovial fluid. CI confidential interval, M–H Mantel–Haenszel, NGS next-generation sequencing
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