Objectives: To evaluate metagenomic next-generation sequencing (mNGS) as a diagnostic tool in detecting pathogens from osteoarticular infection (OAI) samples.

Methods: 130 samples of joint fluid, sonicate fluid, and tissue were prospectively collected from 92 patients with OAI. The performance of mNGS and microbiology culture was compared pairwise.

Results: The overall sensitivity of mNGS was 88.5% (115/130), significantly higher than that of microbiological culture, which had a sensitivity of 69.2% (90/130, p < 0.01). Sensitivity was significantly higher for joint fluid (mNGS: 86.7% vs. microbiology culture: 68.7%, p < 0.01) and sonicate fluid (mNGS: 100% vs. microbiology culture: 66.7%, p < 0.05) samples. mNGS detected 12 pathogenic strains undetected by microbiological culture. Additional pathogens detected by mNGS were Coagulase-negative Staphylococci, Gram-negative Bacillus, Streptococci, Anaerobe, non-tuberculosis mycobacterium, MTCP (p > 0.05), and Mycoplasma (OR = ∞, 95% confidence interval, 5.12–∞, p < 0.001). Additionally, sensitivity by mNGS was higher in antibiotic-treated samples compared to microbiological culture (89.7 vs. 61.5%, p < 0.01).

Conclusions: mNGS is a robust diagnostic tool for pathogenic detection in samples from OAI patients, compared to routine cultures. The mNGS technique is particularly valuable to diagnose pathogens that are difficult to be cultured, or to test samples from patients previously treated with antibiotics.

目标： 评估宏基因组下一代测序（mNGS）作为检测骨关节炎感染（OAI）样品中病原体的诊断工具。

方法：前瞻性收集了92例OAI患者的130份关节液，超声液和组织样本。成对比较mNGS和微生物培养的性能。

结果： mNGS的总体敏感性为88.5％（115/130），显着高于微生物培养的敏感性为69.2％（90/130，115/130）。 p<0.01）。关节液的敏感性明显更高（mNGS：86.7％，而微生物学培养：68.7％，p <0.01）和超声处理液（mNGS：100％，而微生物学培养：66.7％， p<0.05）样本。mNGS检测到12种病原菌株，而微生物培养未检测到。通过mNGS检测到的其他病原体是凝固酶阴性葡萄球菌，革兰氏阴性杆菌，链球菌，厌氧菌，非结核分枝杆菌，MTCP （p > 0.05），以及 支原体 （或=∞，95％置信区间，5.12–∞， p<0.001）。此外，与微生物培养相比，经抗生素处理的样品中mNGS的敏感性更高（89.7对61.5％，p <0.01）。

结论：与常规培养相比，mNGS是用于从OAI患者样本中进行病原体检测的强大诊断工具。mNGS技术对于诊断难以培养的病原体或测试先前用抗生素治疗过的患者的样品特别有价值。