Diagnostic accuracy of 16S rDNA PCR, Multiplex PCR and Metagenomic Next-Generation Sequencing in Periprosthetic Joint Infections: A Systematic Review and Meta-Analysis.

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES

Clinical Microbiology and Infection Pub Date : 2025-02-27 DOI:10.1016/j.cmi.2025.02.022

Flaminia Olearo, Said El Zein, Portillo M Eugenia, Antonia Zapf, Holger Rohde, Elie F Berbari, Marjan Wouthuyzen-Bakker

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引用次数: 0

Abstract

Background: The diagnostic accuracy of 16S rDNA PCR, multiplex PCR (mPCR), and metagenomic next-generation sequencing (mNGS) in periprosthetic joint infections (PJIs) remains unclear.

Objectives: To evaluate the diagnostic accuracy of 16S rDNA PCR, mPCR, and mNGS in PJI.

Data sources: PubMed and EMBASE (January 1, 2000-March 1, 2024), with no language restrictions.

Study eligibility criteria: Studies containing sufficient data to construct a 2×2 contingency table allowing for sensitivity and specificity calculation were considered.

Participants: Adults (≥18 years) with PJI and appropriate control groups.

Tests: 16S rDNA PCR, mPCR, and mNGS.

Reference standard: Diagnosis required adherence to Musculoskeletal Infection Society, Infectious Diseases Society of America (IDSA), International Consensus Meeting, European Bone and Joint Infection Society criteria. Studies employing alternative author-defined criteria were included only if they did not rely solely on positive cultures to define PJI.

Assessment of risk of bias: QUADAS-2 was used.

Methods of data synthesis: A bivariate model calculated pooled diagnostic odds ratios (DORs), sensitivities, and specificities, each with 95% confidence intervals (CIs).

Results: Seventy-nine studies were included, comprising 3,940 PJI cases and 4,700 uninfected controls. Pooled sensitivity/specificity were 80.0% (95% CI: 75.4-84.3%)/94.0% (95% CI: 91-96%) for 16S rDNA PCR; 62.2% (52.5-70.9%)/96.2% (93.2-97.9%) for mPCR; and 88.6% (83.3-92.4%)/93.2% (89.5-95.6%) for mNGS. Notably, mNGS had the highest DOR (105.9; 95% CI: 60-186.9). A sensitivity analysis excluding lower-quality studies resulted in increased DORs for all methods.

Discussion: These molecular techniques display strong diagnostic accuracy for identifying PJI. Although mNGS yielded the highest DOR, numerous technical and practical challenges preclude its routine use for PJI diagnosis. Significant heterogeneity across studies warrants cautious interpretation and underscores the need for future comparative research.

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来源期刊

Clinical Microbiology and Infection 医学-传染病学

CiteScore

25.30

自引率

2.10%

发文量

441

审稿时长

2-4 weeks

期刊介绍： Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.