Diagnostic accuracy and clinical considerations of metagenomic next-generation sequencing in prosthetic joint infection: a systematic review and meta-analysis.

purposeMetagenomic next-generation sequencing (mNGS) has emerged as a promising complementary method for pathogen detection in prosthetic joint infection (PJI). This systematic review and meta-analysis evaluated the diagnostic accuracy of mNGS and conventional microbiological culture.

methodsA systematic review and bivariate diagnostic accuracy meta-analysis were conducted in accordance with the PRISMA-DTA guidelines. PubMed, Ovid MEDLINE, Embase, WoS and the CNKI database were searched. Eligible studies evaluated shotgun mNGS in suspected or confirmed PJI, used a recognized reference standard for diagnosis, and reported sufficient data to construct 2 × 2 contingency tables for mNGS and conventional culture. Pooled sensitivity and specificity were estimated using a bivariate random-effects Reitsma model.

resultsFourteen studies comprising 1,579 cases were included, of which 982 were classified as PJI and 597 as non-PJI. When pooled separately, mNGS had a sensitivity of 84.3% (95% CI 77.3-89.4%) and specificity of 91.5% (95% CI 88.4-93.9%), compared with 66.0% (95% CI 60.1-71.4%) and 95.6% (95% CI 92.8-97.4%), respectively, for conventional culture. The area under the summary receiver operating characteristic (SROC) curve was 0.941 for mNGS and 0.930 for culture. Sensitivity analyses did not change the overall findings.

conclusionWhen analysed separately, mNGS demonstrated higher pooled sensitivity than conventional culture. Overall diagnostic performance assessed by SROC was comparable between the two methods. These findings suggest that mNGS may provide complementary microbiological information. Nevertheless, microorganisms detected exclusively by mNGS should be interpreted cautiously and in conjunction with other clinical and laboratory findings.