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. 2024 Aug 15;38(8):995-1000.
doi: 10.7507/1002-1892.202404044.

[Study on effectiveness of antibiotics guided by metagenomic next-generation sequencing to control infection after total knee arthroplasty]

[Article in Chinese]
Jiaqing Zhu  1 , Jiahao Sun  1 , Bowen Ma  1 , Chiyu Zhang  1 , Xun Cao  1 , Shanbin Zheng  1 , Zhiyuan Chen  1 , Chao Zhang  1 , Jirong Shen  1 , Tianwei Xia  1
Affiliations

[Study on effectiveness of antibiotics guided by metagenomic next-generation sequencing to control infection after total knee arthroplasty]

[Article in Chinese]
Jiaqing Zhu et al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. .

Abstract
in English, Chinese

Objective: To explore the clinical value of metagenomic next-generation sequencing (mNGS) in diagnosis and treatment of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA).

Methods: Between April 2020 and March 2023, 10 patients with PJI after TKA were admitted. There were 3 males and 7 females with an average age of 69.9 years (range, 44-83 years). Infection occurred after 8-35 months of TKA (mean, 19.5 months). The duration of infection ranged from 16 to 128 days (mean, 37 days). The preoperative erythrocyte sedimentation rate (ESR) was 15-85 mm/1 h (mean, 50.2 mm/1 h). The C reactive protein (CRP) was 4.4-410.0 mg/L (mean, 192.8 mg/L). The white blood cell counting was (3.4-23.8)×10 9/L (mean, 12.3×10 9/L). The absolute value of neutrophils was (1.1-22.5)×10 9/L (mean, 9.2×10 9/L). After admission, the joint fluid was extracted for bacterial culture method and mNGS test, and sensitive antibiotics were chosen according to the results of the test, and the infection was controlled in combination with surgery.

Results: Seven cases (70%) were detected as positive by bacterial culture method, and 7 types of pathogenic bacteria were detected; the most common pathogenic bacterium was Streptococcus lactis arrestans. Ten cases (100%) were detected as positive by mNGS test, and 11 types of pathogenic bacteria were detected; the most common pathogenic bacterium was Propionibacterium acnes. The difference in the positive rate between the two methods was significant ( P=0.211). Three of the 7 patients who were positive for both the bacterial culture method and the mNGS test had the same results for the type of pathogenic bacteria, with a compliance rate of 42.86% (3/7). The testing time (from sample delivery to results) was (4.95±2.14) days for bacterial culture method and (1.60±0.52) days for mNGS test, and the difference was significant ( t=4.810, P<0.001). The corresponding sensitive antibiotic treatment was chosen according to the results of bacterial culture method and mNGS test. At 3 days after the one-stage operation, the CRP was 6.8-48.2 mg/L (mean, 23.6 mg/L); the ESR was 17-53 mm/1 h (mean, 35.5 mm/1 h); the white blood cell counting was (4.5-8.1)×10 9/L (mean, 6.1×10 9/L); the absolute value of neutrophils was (2.3-5.7)×10 9/L (mean, 4.1×10 9/L). All patients were followed up 12-39 months (mean, 23.5 months). One case had recurrence of infection at 6 months after operation, and the remaining 9 cases showed no signs of infection, with an infection control rate of 90%.

Conclusion: Compared with bacterial culture method, mNGS test can more rapidly and accurately detect pathogenic bacteria for PJI after TKA, which is important for guiding antibiotics combined with surgical treatment of PJI.

目的: 探讨宏基因组二代测序（metagenomic next-generation sequencing，mNGS）在人工全膝关节置换术（total knee arthroplasty，TKA）后假体周围感染（periprosthetic joint infection，PJI）诊治中的临床价值。.

方法: 2020年4月—2023年3月，收治10例TKA术后PJI患者。男3例，女7例；年龄44～83岁，平均69.9岁。置换术后8～35个月发生感染，平均19.5个月；感染病程16～128 d，平均37 d。术前红细胞沉降率（erythrocyte sedimentation rate，ESR）15～85 mm/1 h，平均50.2 mm/1 h；C 反应蛋白（C reactive protein，CRP）4.4～410.0 mg/L，平均192.8 mg/L；白细胞计数（3.4～23.8）×10 9/L，平均12.3×10 9/L；中性粒细胞绝对值（1.1～22.5）×10 9/L，平均9.2×10 9/L。入院后抽取关节液行细菌培养及mNGS检测，根据检测结果调整敏感抗生素，并结合手术控制感染。.

结果: 细菌培养检测阳性7例（70%），共检出7种病原菌，最常见病原菌为停乳链球菌。mNGS检测阳性10例（100%），共检出11种病原菌，最常见病原菌为痤疮丙酸杆菌。两种方法检测阳性率差异有统计学意义（ P=0.211）。7例细菌培养法和mNGS检测均为阳性患者中，3例病原菌类型结果完全一致，符合率42.86%（3/7）。细菌培养检测时间（送样本至出结果）为（4.95±2.14） d，mNGS检测为（1.60±0.52）d，差异有统计学意义（ t=4.810， P<0.001）。根据细菌培养及mNGS检测培养结果采取敏感抗生素治疗。一期术后3 d CRP为6.8～48.2 mg/L，平均23.6 mg/L；ESR 17～53 mm/1 h，平均35.5 mm/1 h；白细胞计数（4.5～8.1）×10 9/L，平均6.1×10 9/L；中性粒细胞绝对值（2.3～5.7）×10 9/L，平均4.1×10 9/L。患者均获随访，随访时间12～39个月，平均23.5个月。1例术后6个月感染复发，其余9例均未出现感染征象，感染控制率为90%。.

结论: 与细菌培养相比，mNGS能更快速准确地检测TKA术后PJI病原菌，对指导抗生素联合手术治疗PJI具有重要意义。.

Keywords: Metagenomic next-generation sequencing; bacterial culture; diagnosis; periprosthetic joint infection; total knee arthroplasty.

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Conflict of interest statement

利益冲突 在课题研究和文章撰写过程中不存在利益冲突

Figures

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图 1
A typical case 典型病例
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