Abstract

LUCERO, Carlos M. et al. Secuenciación de próxima generación para la detección de patógenos en cirugía de cadera: experiencia y viabilidad diagnóstica en un centro de atención terciaria de la Argentina. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2022, vol.87, n.5, pp.626-635. ISSN 1852-7434.  http://dx.doi.org/https://doi.org/10.15417/issn.1852-7434.2022.87.5.1571.

Introduction: Early diagnosis of a periprosthetic joint infection (PJI) and identification of the pathogen are paramount. Next-generation sequencing (NGS) can identify the nucleic acids in a given germ in a short period. To our knowledge, there are no reports of its use in the management of PJI in South America. Our objective was to demonstrate the diagnostic feasibility of the NGS technique on the samples obtained from a series of patients operated on in Buenos Aires, Argentina. Materials and Methods: A prospective series of 20 patients undergoing septic and aseptic hip revision surgery from December 2019 to March 2020 was analyzed. Intraoperative samples of synovial fluid, deep tissue, and intramedullary canal were obtained and sent to the NexGen Microgen laboratory (Texas, USA) for analysis. Results: Seventeen patients were finally eligible to present a sample suitable for analysis. In 100% of the samples, NGS results were obtained within 72 hours of surgery. In one case, the NGS result reported a germ different from the one identified in the postoperative soft tissue cultures, allowing antibiotic therapy to be corrected. In another case, NGS identified Parabacteroides gordonii in aseptic revision surgery. In another patient, the NGS identified Morganella morganii, in which conventional postoperative cultures were negative in single-stage revision surgery. Conclusion: In this study, we demonstrated the diagnostic feasibility of NGS, obtaining results within 72 hours immediately after surgery for pathogenic organisms in patients with PJI and negative cultures.

Keywords : Periprosthetic joint infection; next generation sequencing; revision surgery; hip arthroplasty.