DataSheet_3_Will previous antimicrobial therapy reduce the positivity rate of metagenomic next-generation sequencing in periprosthetic joint infections? A clinical study.pdf

BackgroundMetagenomic next-generation sequencing (mNGS) is a culture-independent massively parallel DNA sequencing technology and it has been widely used for rapid etiological diagnosis with significantly high positivity rate. Currently, clinical studies on evaluating the influence of previous antimicrobial therapy on positivity rate of mNGS in PJIs are rarely reported. The present study aimed to investigate whether the positivity rate of mNGS is susceptible to previous antimicrobial therapy.
MethodsWe performed a prospective trial among patients who undergone hip or knee surgery due to periprosthetic joint infection (PJI) to compare the positivity rate of culture and mNGS between cases with and without previous antimicrobial therapy, and the positivity rates between cases with different antimicrobial-free intervals were also analysed.
ResultsAmong 131 included PJIs, 91 (69.5%) had positive cultures and 115 (87.8%) had positive mNGS results. There was no significant difference in the positivity rate of deep-tissue culture and synovial fluid mNGS between cases with and without previous antimicrobial therapy. The positivity rate of synovial fluid culture was higher in cases with previous antimicrobial therapy. The positivity rates of mNGS in synovial fluid decreased as the antimicrobial-free interval ranged from 4 to 14 days to 0 to 3 days.
ConclusionmNGS is more advantageous than culture with a higher pathogen detection rate. However, our data suggested that antimicrobial agents may need to be discontinued more than 3 days before sampling to further increase the positivity rate of mNGS for PJIs.

背景：宏基因组下一代测序（metagenomic next-generation sequencing, mNGS）是一种无需培养的大规模并行DNA测序技术，已被广泛用于快速病原学诊断，且阳性检出率显著较高。目前针对抗菌药物治疗对假体周围关节感染（periprosthetic joint infection, PJI）患者宏基因组下一代测序阳性率影响的临床研究鲜有报道。本研究旨在探讨宏基因组下一代测序的阳性检出率是否会受既往抗菌药物治疗的影响。
方法：本研究针对因假体周围关节感染（periprosthetic joint infection, PJI）接受髋或膝关节手术的患者开展一项前瞻性试验，对比既往接受过与未接受过抗菌药物治疗患者的培养与宏基因组下一代测序阳性检出率，并分析不同抗菌药物停药间期患者的阳性检出率差异。
结果：本研究共纳入131例假体周围关节感染患者，其中91例（69.5%）培养结果呈阳性，115例（87.8%）宏基因组下一代测序结果呈阳性。既往接受过与未接受过抗菌药物治疗患者的深部组织培养与滑膜液宏基因组下一代测序阳性检出率无显著差异。既往接受过抗菌药物治疗患者的滑膜液培养阳性检出率更高。随着抗菌药物停药间期从4~14天缩短至0~3天，滑膜液宏基因组下一代测序的阳性检出率逐渐降低。
结论：宏基因组下一代测序的病原检出率高于培养法，具有更显著的优势。但本研究数据提示，若要进一步提升假体周围关节感染患者宏基因组下一代测序的阳性检出率，需在采样前停用抗菌药物超过3天。