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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2023

Open Access 16-10-2022 | Joint Infection | KNEE

Higher sensitivity and accuracy of synovial next-generation sequencing in comparison to culture in diagnosing periprosthetic joint infection: a systematic review and meta-analysis

Authors: Ashraf T. Hantouly, Osama Alzobi, Ahmad A. Toubasi, Bashir Zikria, Mohammed Al Ateeq Al Dosari, Ghalib Ahmed

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2023

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Abstract

Purpose

The purpose of this meta-analysis was to compare the diagnostic parameters of synovial next-generation sequencing (NGS) and cultures in diagnosing periprosthetic joint infections (PJI).

Methods

PubMed, Web of Science, Cochrane, and Google Scholar were searched from inception until 8 Jan 2022 for literature investigating the role of NGS in comparison to culture in the diagnosis of PJI. The studies were included if they investigated the diagnostic value of culture and NGS in diagnosing PJIs against the Musculoskeletal Infection Society (MSIS) criteria. Diagnostic parameters, such as sensitivity, specificity, positive predictive value, negative predictive value, positive-likelihood ratio, negative-likelihood ratio, accuracy, and area under the curve (AUC), were calculated for the included studies to evaluate the performance of NGS in comparison to culture in PJI diagnosis.

Results

The total number of the included patients was 341 from seven articles. The pooled sensitivity, specificity, and diagnostic odds ratio of NGS were 94% (95% CI 91–97%), 89% (95% CI 82–95%), and 138.5 (95% CI 49.1–390.5), respectively. NGS has positive- and negative-likelihood ratios of 7.9 (95% CI 3.99–15.6) and 0.1 (95% CI 0.0–0.1), respectively. On the other hand, the pooled sensitivity, specificity, and diagnostic odds ratio of culture were 70% (95% CI 61–79%), 94% (95% CI 88–98%), and 28.0 (95% CI 12.6–62.2), respectively. The SROC curve for NGS showed that the accuracy (AUC) was 91.9%, and that the positive and negative predictive values were 8.6 (95% CI 5.0–19.5) and 0.1 (95% CI 0.0–0.1), respectively. While, culture SROC curve demonstrated that the accuracy (AUC) was 80.5% and the positive- and negative-likelihood ratio were 12.1 (95% CI 4.5–49.6) and 0.3 (95% CI 0.2–0.4).

Conclusions

NGS has a potential role in diagnosing hip and knee PJIs due to its high sensitivity, specificity, and accuracy. However, the sensitivity and specificity reported by the studies varied according to the time of synovial sampling (preoperative, postoperative, or mixed).
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Metadata
Title
Higher sensitivity and accuracy of synovial next-generation sequencing in comparison to culture in diagnosing periprosthetic joint infection: a systematic review and meta-analysis
Authors
Ashraf T. Hantouly
Osama Alzobi
Ahmad A. Toubasi
Bashir Zikria
Mohammed Al Ateeq Al Dosari
Ghalib Ahmed
Publication date
16-10-2022
Publisher
Springer Berlin Heidelberg
Keyword
Joint Infection
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-022-07196-9

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