Microbial Culture and Metagenomic Next-Generation Sequencing (mNGS) Results-Oriented Antibiotic Regimen (MCM-ROAR) Improve Clinical Outcomes of Periprosthetic Joint Infection.

Abstract

This study aimed to assess the utility of a microbial culture and metagenomic next-generation sequencing (mNGS) results-oriented antibiotic regimen (MCM-ROAR) in the management of periprosthetic joint infection (PJI). Patients suspected of PJI at our center were included in the study. Synovial fluid and periprosthetic tissues were collected for microbial culture and mNGS, and the results were interpreted by a panel of PJI experts. Following surgical intervention, patients were treated with antibiotics according to the MCM-ROAR procedure recommended by the panel and received regular follow-up care. Data on medical records, infection control practices, and rates of antibiotic-related complications were documented and analyzed for comparison. The study included 216 PJI cases, among which 143 underwent both microbial culture and mNGS testing. Of these, 100 cases were culture-positive, while 43 cases were culture-negative. Overall, a total of 53 (37.0%) PJI cases that underwent both microbial culture and mNGS testing modified their antibiotic regimens based on mNGS results. The overall infection control rate was approximately 86.8% (131 of 151) in culture-positive PJI cases and 81.5% (53 of 65) in culture-negative PJI cases. In culture-negative PJI cases, mNGS testing and modification of antibiotic regimens based on mNGS results significantly improved infection control rates compared with PJI cases without mNGS testing (94.4 versus 63.6%; P = 0.009), while decreasing the incidence of antibiotic-related complications (8.8 versus 36.4%; P = 0.017). In conclusion, mNGS is an instructive diagnostic tool for PJI, and treating PJI with MCM-ROAR could markedly improve the clinical outcomes of PJI.