The role of metagenomic next-generation sequencing in the pathogen detection of invasive osteoarticular infection

Objectives: This study aimed to analyze the pathogenic bacteria spectrum in invasive and primary os-teoarticular infection (IOI and POI) and compare the pathogen detection rate of metagenomic next -generation sequencing (mNGS) and microbial culture in IOI and POI. Methods: The suspected POI and IOI cases from 2014-2021 were included. The diagnosis of POI or IOI was made by at least two orthopedic surgeons, two infectious diseases specialists, and one senior microbiolo-gist. Demographic characteristics, microbial culture results, and so on were recorded. The pathogenic bac-teria spectrum in IOI and POI were analyzed, and the ability of mNGS and microbial culture in pathogen detection in IOI and POI were compared.Results: There were 52 POI cases and 92 IOI cases; the common pathogen in POI and IOI were both Staphylococcus aureus. There are more cases with negative microbial culture results and multiple infec-tions in IOI, and many cases were caused by rare and fastidious bacteria. The introduction of the mNGS could significantly increase the pathogen detection rate to 92.39% in IOI, which was 8.69% higher than that of microbial culture ( P = 0.007), whereas the improvement in POI was limited to about 2%.Conclusion: mNGS is an promising tool for IOI pathogen detection.(c) 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )