Comprehensive analysis of culture-negative periprosthetic joint infection with metagenomic next-generation sequencing.

Objective: This study aimed to identify the risk factors and microbial profiles of patients with culture-negative periprosthetic joint infection (PJI) using metagenomic next generation sequencing (mNGS) and to compare the clinical characteristics and treatment outcomes of culture-negative PJI (CN PJI) with culture-positive PJI (CP PJI). Methods: A retrospective analysis was conducted on 223 patients who met the International Consensus Meeting criteria for PJI and underwent surgical treatment at our hospital between February 2013 and January 2023. Clinical and follow-up data, including microbiological culture results and mNGS findings, were collected. Based on culture results, patients were divided into the CP PJI and CN PJI groups. Risk factors and microbial profiles of CN PJI patients were summarized with the aid of mNGS results. Differences in clinical characteristics and treatment outcomes between the two groups were also analyzed. Results: Among the 223 patients, 168 were in the CP PJI group, and 55 were in the CN PJI group. Risk factors for negative cultures included polymicrobial infections, infections caused by rare pathogens, and prolonged antibiotic use prior to sampling. In the CN PJI group, over a quarter of cases involved polymicrobial infections (25.5%) or rare pathogen infections (38.2%), with Conclusion: CN PJI presents a unique microbial spectrum and distinct clinical therapeutic characteristics. mNGS offers a more comprehensive understanding of infecting microorganisms, particularly those often missed by conventional culture techniques. With advancements in sample collection, optimized culture methods, molecular diagnostic tools, and early targeted therapies, CN PJI may achieve clinical outcomes comparable to CP PJI.