二代测序技术在人工关节感染病原学诊断中的应用

Application of next-generation sequencing in the diagnosis of periprosthetic joint infection pathogens

目的研究应用宏基因组二代测序技术(metagenomic next-generation sequencing,mNGS)在人工关节感染(periprosthetic joint infection,PJI)病原学诊断中的价值,为临床选择诊断技术提供经验。方法收集2017年1月-2019年12月复旦大学附属中山医院收治的疑似PJI患者的临床资料。通过对术中关节液和假体周围组织进行常规病原培养和mNGS检测,结合临床表现及治疗效果确认致病病原体。结果根据美国骨骼肌肉感染协会(Musculoskeletal Infection Society,MSIS)诊断标准,13例患者诊断为PJI,mNGS检出阳性率为84.62%,高于培养阳性率(76.92%),主要检出病原体为金黄色葡萄球菌、屎肠球菌、白假丝酵母菌、人型支原体等。mNGS检测时间为48 h,较培养法用时少。结论mNGS可快速检测PJI,从病原学角度为临床早期诊断PJI提供依据,是传统培养方法的重要补充,尤其在诊断培养阴性PJI方面具有优势。

Objective To evaluate the capability of metagenomic next-generation sequencing(mNGS)in the pathogen diagnosis of periprosthetic joint infection(PJI)in order to provide clinical experience of choosing diagnostic methods.Methods From Jan 2017 to Dec 2019,patients with borderline symptoms were involved in this study.Intraoperative synovial fluid and periprosthetic tissues were both collected for microbial culture and mNGS.The pathogens were identified by symptoms,therapy and positive results.Results According to the criteria of Musculoskeletal Infection Society(MSIS),13 patients were diagnosed as PJI.The positive rate of mNGS was 84.62%,which was higher than that of culture method(76.92%).Staphylococcus aureus,Enterococcus faecium,Candida albicans and Mycoplasma hominis were the main detected pathogens of PJI.The detection time of mNGS was 48 h,which was significantly shorter than culture method(14 d).Conclusion With higher speed of detection in PJI,mNGS can provide vital etiological evidence for early accurate diagnosis of PJI.mNGS is an effective complement to microbial culture method,especially in culture-negative PJI.