Detection of rare microorganisms in bone and joint infections by metagenomic next-generation sequencing discrimination, decision-making, and clinical benefits

• Published in: Bone & joint research Vol. 13; no. 8; pp. 401 - 410
• Main Authors: Hu, Hongxin, Ding, Haiqi, Lyu, Jianhua, Chen, Yang, Huang, Changyu, Zhang, Chaofan, Li, Wenbo, Fang, Xinyu, Zhang, Wenming
• Format: Journal Article
• Language: English
• Published: London The British Editorial Society of Bone & Joint Surgery 15.08.2024
• Subjects: antibiotics; bacteria; bone and joint infections; chi- squared test; clinical diagnosis; clinicians; Infection; infections; joint infections; metagenomic next-generation sequencing; microorganisms; rare microorganisms; retrospective analysis; t-test
• ISSN: 2046-3758
• DOI: 10.1302/2046-3758.138.BJR-2023-0420.R1

Aims: This aim of this study was to analyze the detection rate of rare pathogens in bone and joint infections (BJIs) using metagenomic next-generation sequencing (mNGS), and the impact of mNGS on clinical diagnosis and treatment. Methods: A retrospective analysis was conducted on 235 patients with BJIs who were treated at our hospital between January 2015 and December 2021. Patients were divided into the no-mNGS group (microbial culture only) and the mNGS group (mNGS testing and microbial culture) based on whether mNGS testing was used or not. Results: A total of 147 patients were included in the no-mNGS group and 88 in the mNGS group. The mNGS group had a higher detection rate of rare pathogens than the no-mNGS group (21.6% vs 10.2%, p = 0.016). However, the mNGS group had lower rates of antibiotic-related complications, shorter hospital stays, and higher infection control rates compared with the no-mNGS group (p = 0.017, p = 0.003, and p = 0.028, respectively), while there was no significant difference in the duration of antibiotic use (p = 0.957). In culture-negative cases, the mNGS group had lower rates of antibiotic-related complications, shorter hospital stays, and a higher infection control rate than the no-mNGS group (p = 0.036, p = 0.033, p = 0.022, respectively), while there was no significant difference in the duration of antibiotic use (p = 0.748). Conclusion: mNGS improves detection of rare pathogens in BJIs. mNGS testing reduces antibiotic-related complications, shortens hospital stay and antibiotic use duration, and improves treatment success rate, benefits which are particularly evident in culture-negative cases. Cite this article: Bone Joint Res 2024;13(8):401–410.