Abstarct:

Periprosthetic joint infection (PJI) continues to be a severe complication of arthroplasty, with up to 30% of cases testing culture-negative. Metagenomic next-generation sequencing (mNGS) provides an unbiased and swift method, taking less than 48 hours to detect pathogens directly from joint fluid and tissue. This review compiles clinical data, especially from Shi et al. (2024), comparing mNGS (89.1% sensitivity, 94.7% specificity) to traditional culture methods (sensitivity of 67.4%) in 65 suspected PJI cases. mNGS successfully identified 17 pathogens in 14 culture-negative samples, including Cutibacterium acnes and Coxiella burnetii, though it missed 4 culture-positive infections. The review details pre-analytical elements (such as sample collection, host DNA removal), sequencing processes (like Illumina NextSeq), and bioinformatics analyses (quality control, host DNA subtraction, microbial alignment). Table 1 presents diagnostic metrics; Table 2 lists identified pathogens; Figure 1 shows the mNGS process; Figure 2 compares microbial distributions. Limitations such as false negatives, expenses, and issues with standardization are discussed, along with future recommendations: improved lysis techniques, real-time nanopore sequencing, combining antimicrobial resistance profiling, conducting multicenter validation studies, and analyzing cost-effectiveness. Adhering to rigorous standard operating procedures and clinical guidelines is crucial for integrating mNGS into routine PJI diagnostics.