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Next-generation sequencing not superior to culture in periprosthetic joint infection diagnosis.

Publication ,  Journal Article
Kildow, BJ; Ryan, SP; Danilkowicz, R; Lazarides, AL; Penrose, C; Bolognesi, MP; Jiranek, W; Seyler, TM
Published in: Bone Joint J
January 2021

AIMS: Use of molecular sequencing methods in periprosthetic joint infection (PJI) diagnosis and organism identification have gained popularity. Next-generation sequencing (NGS) is a potentially powerful tool that is now commercially available. The purpose of this study was to compare the diagnostic accuracy of NGS, polymerase chain reaction (PCR), conventional culture, the Musculoskeletal Infection Society (MSIS) criteria, and the recently proposed criteria by Parvizi et al in the diagnosis of PJI. METHODS: In this retrospective study, aspirates or tissue samples were collected in 30 revision and 86 primary arthroplasties for routine diagnostic investigation for PJI and sent to the laboratory for NGS and PCR. Concordance along with statistical differences between diagnostic studies were calculated. RESULTS: Using the MSIS criteria to diagnose PJI as the reference standard, the sensitivity and specificity of NGS were 60.9% and 89.9%, respectively, while culture resulted in sensitivity of 76.9% and specificity of 95.3%. PCR had a low sensitivity of 18.4%. There was no significant difference based on sample collection method (tissue swab or synovial fluid) (p = 0.760). There were 11 samples that were culture-positive and NGS-negative, of which eight met MSIS criteria for diagnosing infection. CONCLUSION: In our series, NGS did not provide superior sensitivity or specificity results compared to culture. PCR has little utility as a standalone test for PJI diagnosis with a sensitivity of only 18.4%. Currently, several laboratory tests for PJI diagnosis should be obtained along with the overall clinical picture to help guide decision-making for PJI treatment. Cite this article: Bone Joint J 2021;103-B(1):26-31.

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Published In

Bone Joint J

DOI

EISSN

2049-4408

Publication Date

January 2021

Volume

103-B

Issue

1

Start / End Page

26 / 31

Location

England

Related Subject Headings

  • Sensitivity and Specificity
  • Retrospective Studies
  • Reference Standards
  • Prosthesis-Related Infections
  • Polymerase Chain Reaction
  • Middle Aged
  • Male
  • Humans
  • High-Throughput Nucleotide Sequencing
  • Female
 

Citation

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Kildow, B. J., Ryan, S. P., Danilkowicz, R., Lazarides, A. L., Penrose, C., Bolognesi, M. P., … Seyler, T. M. (2021). Next-generation sequencing not superior to culture in periprosthetic joint infection diagnosis. Bone Joint J, 103-B(1), 26–31. https://doi.org/10.1302/0301-620X.103B1.BJJ-2020-0017.R3
Kildow, Beau J., Sean P. Ryan, Richard Danilkowicz, Alexander L. Lazarides, Colin Penrose, Michael P. Bolognesi, William Jiranek, and Thorsten M. Seyler. “Next-generation sequencing not superior to culture in periprosthetic joint infection diagnosis.Bone Joint J 103-B, no. 1 (January 2021): 26–31. https://doi.org/10.1302/0301-620X.103B1.BJJ-2020-0017.R3.
Kildow BJ, Ryan SP, Danilkowicz R, Lazarides AL, Penrose C, Bolognesi MP, et al. Next-generation sequencing not superior to culture in periprosthetic joint infection diagnosis. Bone Joint J. 2021 Jan;103-B(1):26–31.
Kildow, Beau J., et al. “Next-generation sequencing not superior to culture in periprosthetic joint infection diagnosis.Bone Joint J, vol. 103-B, no. 1, Jan. 2021, pp. 26–31. Pubmed, doi:10.1302/0301-620X.103B1.BJJ-2020-0017.R3.
Kildow BJ, Ryan SP, Danilkowicz R, Lazarides AL, Penrose C, Bolognesi MP, Jiranek W, Seyler TM. Next-generation sequencing not superior to culture in periprosthetic joint infection diagnosis. Bone Joint J. 2021 Jan;103-B(1):26–31.

Published In

Bone Joint J

DOI

EISSN

2049-4408

Publication Date

January 2021

Volume

103-B

Issue

1

Start / End Page

26 / 31

Location

England

Related Subject Headings

  • Sensitivity and Specificity
  • Retrospective Studies
  • Reference Standards
  • Prosthesis-Related Infections
  • Polymerase Chain Reaction
  • Middle Aged
  • Male
  • Humans
  • High-Throughput Nucleotide Sequencing
  • Female