探讨宏基因二代测序技术在关节置换术后假体周围感染病原菌检测中的应用价值。

回顾性分析2018年1月至2019年10月西安市红会医院收治的诊断为关节置换术后假体周围感染患者临床资料，排除2周内应用抗生素患者及由于送检标本质量不合格导致mNGS检测失败者，最终纳入研究者34例，所有患者均取术中样本送细菌培养及宏基因二代测序检测，分别记录细菌培养及宏基因二代测序结果，记录阳性例数，比较阳性率及检测所需时间，记录两种检测方法的菌种类别，采用配对卡方检验或配对t检验进行统计学分析。

总计34例假体周围感染患者中，男14例，女20例，平均年龄(67.9±11.7)岁；膝关节感染23例，髋关节感染11例。细菌培养阳性者20例，阳性率58.8%，宏基因二代测序检测阳性者30例，阳性率88.2%，差异有统计学意义(χ²＝7.556，P<0.05)。从微生物标本送检至报告结果，细菌培养所需时间平均为(5.2±2.1)d，宏基因二代测序检测所需时间平均为(1.6±0.6)d，差异有统计学意义(t ＝9.678，P<0.05)。两种方法所测病原微生物均以革兰阳性菌为主，最常见的3种病原体是金黄色葡萄球菌、表皮葡萄球菌和大肠埃希菌。

采用宏基因二代测序检测方法细菌检出率明显高于细菌培养，所需时间明显短于细菌培养，在人工关节置换术后假体周围感染患者病原菌检测中更有优势。

To explore the value of metagenomic next-generation sequencing in pathogen detection of periprosthetic joint infection.

From January 2018 to October 2019, the data of patients who were diagnosed as periprosthetic joint infection in Hong-Hui Hospital of Xi’an Jiaotong University were analyzed retrospectively. The patients who received antibiotics within two weeks before sampling and failed to do mNGS detection due to substandard samples were excluded, and 34 patients were eventually included. All the patients were detected using the metagenomicnext-generation sequencing and bacterial culture simultaneously with recording the positive numbers anddetectiontime, as well as identifying bacterial species. The detection rates of metagenomic next-generation sequencing and bacterial culture in PJI patients were calculated and statistically analyzed by paired chi-square test.The detection time was analyzed by student's t test.

Among the 34 patients with periprosthetic joint infection, there were 14 males and 20 females and involving 23 knees and 11 hips with an average age of (67.9±11.7) years. The positive rate of bacterial culture was 58.8%, whereas the positive rate of metagenomic next-generation sequencing was 88.2% and the difference was statistically significant (χ²=7.556, P < 0.05). The detection time of bacterial culture was (5.2±2.1) d, whereas the detection time of metagenomic next-generation sequencing was (1.6±0.6) d and the difference was statistically significant (t =9.678, P <0.05). Gram-positive bacteria was the main pathogen for periprosthetic joint infection and the most common bacteria were staphylococcus aureus, staphylococcus epidermidis and escherichia coli for both two methods.

Compared with bacterial culture, the metagenomic next-generation sequencing technology has a higher positive rate and shorter detection time, which might be greater valuable in prosthetic joint infection after joint replacement.