Evaluation of targeted sequencing for pathogen identification in bone and joint infections: a cohort study from China.

IF 4.6 2区医学 Q1 MICROBIOLOGY Annals of Clinical Microbiology and Antimicrobials Pub Date : 2024-08-22 DOI:10.1186/s12941-024-00733-z

Qiang Zhang, Yonghua Ding, Quanzhong Ren, Feng Zhang, Guoqiang Lyu, Tongxin Lu, Zhen Song, Qing Wang, Yongxiang Cheng, Jing Wang, Hongcang Gu

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Abstract

Purpose: Bone and joint tuberculosis (BJTB) is a distinct variant of tuberculosis in which clinical diagnosis often leads to relative misdiagnosis and missed diagnoses. This study aimed to evaluate the diagnostic accuracy of the targeted nanopore sequencing (TNPseq) assay for BJTB patients in China.

Method: The study enrolled a cohort of 163 patients with suspected BJTB. Diagnostic testing was performed using the TNPseq assay on samples including punctured tissue, pus, and blood. The diagnostic accuracy of the TNPseq assay was then compared with that of the T-SPOT and Xpert MTB/RIF assays.

Result: TNPseq exhibited superior performance in terms of accuracy, demonstrating a sensitivity of 76.3% (95% CI: 71.0-81.6%) and a specificity of 98.8% (95% CI: 93.5-100%) in clinical diagnosis. When evaluated against a composite reference standard, TNPseq demonstrated a sensitivity of 74.4% (95% CI: 69.3-79.5%) and a specificity of 98.8% (95% CI: 93.7-100%). These results exceed the performance of both the T-SPOT and Xpert MTB/RIF tests. Notably, TNPseq demonstrated high specificity and accuracy in puncture specimens, with a sensitivity of 75.0% (95% CI: 70.2-79.8%) and a specificity of 98.3% (95% CI: 92.7-100%), as well as in pus samples, with a sensitivity of 83.3% (95% CI: 78.6-88.1%) and a specificity of 100% (95% CI: 100-100%). Additionally, TNPseq facilitated the detection of mixed infection scenarios, identifying 20 cases of bacterial-fungal co-infection, 17 cases of bacterial-viral co-infection, and two cases of simultaneous bacterial-fungal-viral co-infection.

Conclusion: TNPseq demonstrated great potential in the diagnosis of BJTB due to its high sensitivity and specificity. The ability of TNPseq to diagnose pathogens and detect drug resistance genes can also guide subsequent treatment. Expanding the application scenarios and scope of TNPseq will enable it to benefit more clinical treatments.

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骨与关节感染病原体鉴定的靶向测序评估：一项来自中国的队列研究。

目的：骨与关节结核（BJTB）是结核病的一个独特变种，临床诊断常常导致相对误诊和漏诊。本研究旨在评估靶向纳米孔测序（TNPseq）对中国骨与关节结核患者的诊断准确性：方法：本研究招募了 163 例疑似 BJTB 患者。采用 TNPseq 法对穿刺组织、脓液和血液等样本进行诊断检测。然后将 TNPseq 检测方法的诊断准确性与 T-SPOT 和 Xpert MTB/RIF 检测方法进行比较：结果：TNPseq 在准确性方面表现优异，临床诊断灵敏度为 76.3%（95% CI：71.0-81.6%），特异性为 98.8%（95% CI：93.5-100%）。对照综合参考标准进行评估时，TNPseq 的灵敏度为 74.4%（95% CI：69.3-79.5%），特异性为 98.8%（95% CI：93.7-100%）。这些结果超过了 T-SPOT 和 Xpert MTB/RIF 检测的性能。值得注意的是，TNPseq 在穿刺样本中表现出很高的特异性和准确性，灵敏度为 75.0%（95% CI：70.2-79.8%），特异性为 98.3%（95% CI：92.7-100%）；在脓液样本中，灵敏度为 83.3%（95% CI：78.6-88.1%），特异性为 100%（95% CI：100-100%）。此外，TNPseq还有助于检测混合感染情况，共鉴定出20例细菌-真菌混合感染、17例细菌-病毒混合感染和2例细菌-真菌-病毒同时混合感染：TNPseq具有高灵敏度和特异性，在诊断BJTB方面具有巨大潜力。TNPseq诊断病原体和检测耐药基因的能力还能指导后续治疗。扩大 TNPseq 的应用场景和范围将使其惠及更多的临床治疗。

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来源期刊

Annals of Clinical Microbiology and Antimicrobials MICROBIOLOGY-

CiteScore

8.60

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Annals of Clinical Microbiology and Antimicrobials considers good quality, novel and international research of more than regional relevance. Research must include epidemiological and/or clinical information about isolates, and the journal covers the clinical microbiology of bacteria, viruses and fungi, as well as antimicrobial treatment of infectious diseases. Annals of Clinical Microbiology and Antimicrobials is an open access, peer-reviewed journal focusing on information concerning clinical microbiology, infectious diseases and antimicrobials. The management of infectious disease is dependent on correct diagnosis and appropriate antimicrobial treatment, and with this in mind, the journal aims to improve the communication between laboratory and clinical science in the field of clinical microbiology and antimicrobial treatment. Furthermore, the journal has no restrictions on space or access; this ensures that the journal can reach the widest possible audience.