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Peer-reviewedCC BYFrontiers in cellular and infection microbiology

Metagenomic next-generation sequencing in tuberculous periprosthetic joint infection: pathogen-detection yield and clinical characteristics compared with common bacterial PJI.

  • Jiayu Li1,2,3,4
  • Yuntao Liao1,2,3,4
  • Xiaolin Li5
  • Lan Lin1,2,3,4
  • Yafei Liu1,2,3,4
  • Wenbo Li1,2,3,4
  • Zida Huang1,2,3,4
  • Zhaoyang Wu1,2,3,4
  • Xinyu Fang1,2,3,4
  • Wenming Zhang1,2,3,4
5 affiliations
  1. 1Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
  2. 2Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
  3. 3Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
  4. 4Fujian Orthopedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
  5. 5Department of Orthopaedic Surgery, Wuping County Hospital, Longyan, China.
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Abstract

Objective

To compare the pathogen-detection yield of metagenomic next-generation sequencing (mNGS) and conventional culture in tuberculous periprosthetic joint infection (TB-PJI) and common bacterial PJI (CB-PJI), and to characterize clinical differences and exploratory associations with TB-PJI.Methods

A retrospective cohort included 197 patients with periprosthetic joint infection treated between January 2016 and June 2024 who underwent both conventional culture and mNGS during the same diagnostic or surgical episode. Patients were classified as CB-PJI (n=178) or TB-PJI (n=19). Paired pathogen-detection rates were compared using McNemar's test. Exploratory multivariable associations with TB-PJI were assessed using Firth penalized logistic regression with the Charlson Comorbidity Index (CCI) modeled continuously.Results

In CB-PJI, mNGS showed a higher pathogen-detection rate than conventional bacterial culture (94.4% vs. 78.1%, P<0.001). In TB-PJI, Mycobacterium tuberculosis complex (MTBC) was detected by mNGS in 17/19 cases (89.5%) and recovered by mycobacterial culture in 5/19 cases (26.3%; P<0.001); 12/19 cases were mNGS-positive/mycobacterial-culture-negative. In the primary exploratory Firth model, each 1-point increase in CCI was associated with higher odds of TB-PJI (aOR=2.39, 95% CI: 1.51-4.10, P<0.001), whereas each 10% increase in SF PMN% was associated with lower odds (aOR=0.722, 95% CI: 0.564-0.917, P = 0.009); BMI was not statistically significant. Drug-related complications were more frequent in TB-PJI (42.1% vs. 11.8%, P = 0.002), while the 2-year infection recurrence rate did not differ significantly (15.8% vs. 7.9%, P = 0.216).Conclusion

In this selected retrospective cohort, mNGS provided a higher pathogen-detection yield than conventional culture, particularly for TB-PJI. Higher CCI and lower SF PMN% were exploratory clinical associations with TB-PJI and should not be interpreted as validated diagnostic thresholds. mNGS should be considered an adjunct to mycobacterial culture, molecular testing, and histopathology rather than a stand-alone diagnostic test.

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Cite

BibTeXRIS
BibTeX
@article{li2026metagenomic,
  title = {{Metagenomic next-generation sequencing in tuberculous periprosthetic joint infection: pathogen-detection yield and clinical characteristics compared with common bacterial PJI.}},
  author = {Jiayu Li and Yuntao Liao and Xiaolin Li and Lan Lin and Yafei Liu and Wenbo Li and Zida Huang and Zhaoyang Wu and Xinyu Fang and Wenming Zhang},
  journal = {Frontiers in cellular and infection microbiology},
  year = {2026},
  month = oct,
  doi = {10.3389/fcimb.2026.1935713},
  url = {https://europepmc.org/article/MED/42908611},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Metagenomic next-generation sequencing in tuberculous periprosthetic joint infection: pathogen-detection yield and clinical characteristics compared with common bacterial PJI.
AU  - Jiayu Li
AU  - Yuntao Liao
AU  - Xiaolin Li
AU  - Lan Lin
AU  - Yafei Liu
AU  - Wenbo Li
AU  - Zida Huang
AU  - Zhaoyang Wu
AU  - Xinyu Fang
AU  - Wenming Zhang
PY  - 2026
DA  - 2026/10/07
JO  - Frontiers in cellular and infection microbiology
DO  - 10.3389/fcimb.2026.1935713
UR  - https://europepmc.org/article/MED/42908611
AB  - Objective  To compare the pathogen-detection yield of metagenomic next-generation sequencing (mNGS) and conventional culture in tuberculous periprosthetic joint infection (TB-PJI) and common bacterial PJI (CB-PJI), and to characterize clinical differences and exploratory associations with TB-PJI.Methods  A retrospective cohort included 197 patients with periprosthetic joint infection treated between January 2016 and June 2024 who underwent both conventional culture and mNGS during the same diagnostic or surgical episode. Patients were classified as CB-PJI (n=178) or TB-PJI (n=19). Paired pathogen-detection rates were compared using McNemar's test. Exploratory multivariable associations with TB-PJI were assessed using Firth penalized logistic regression with the Charlson Comorbidity Index (CCI) modeled continuously.Results  In CB-PJI, mNGS showed a higher pathogen-detection rate than conventional bacterial culture (94.4% vs. 78.1%, P<0.001). In TB-PJI, Mycobacterium tuberculosis complex (MTBC) was detected by mNGS in 17/19 cases (89.5%) and recovered by mycobacterial culture in 5/19 cases (26.3%; P<0.001); 12/19 cases were mNGS-positive/mycobacterial-culture-negative. In the primary exploratory Firth model, each 1-point increase in CCI was associated with higher odds of TB-PJI (aOR=2.39, 95% CI: 1.51-4.10, P<0.001), whereas each 10% increase in SF PMN% was associated with lower odds (aOR=0.722, 95% CI: 0.564-0.917, P = 0.009); BMI was not statistically significant. Drug-related complications were more frequent in TB-PJI (42.1% vs. 11.8%, P = 0.002), while the 2-year infection recurrence rate did not differ significantly (15.8% vs. 7.9%, P = 0.216).Conclusion  In this selected retrospective cohort, mNGS provided a higher pathogen-detection yield than conventional culture, particularly for TB-PJI. Higher CCI and lower SF PMN% were exploratory clinical associations with TB-PJI and should not be interpreted as validated diagnostic thresholds. mNGS should be considered an adjunct to mycobacterial culture, molecular testing, and histopathology rather than a stand-alone diagnostic test.
SN  - 2235-2988
ER  -