{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:50:02Z","timestamp":1791352202376,"version":"4.3.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the pathogen-detection yield of metagenomic next-generation sequencing (mNGS) and conventional culture in tuberculous periprosthetic joint infection (TB-PJI) and common bacterial PJI (CB-PJI), and to characterize clinical differences and exploratory associations with TB-PJI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort included 197 patients with periprosthetic joint infection treated between January 2016 and June 2024 who underwent both conventional culture and mNGS during the same diagnostic or surgical episode. Patients were classified as CB-PJI (n=178) or TB-PJI (n=19). Paired pathogen-detection rates were compared using McNemar\u2019s test. Exploratory multivariable associations with TB-PJI were assessed using Firth penalized logistic regression with the Charlson Comorbidity Index (CCI) modeled continuously.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In CB-PJI, mNGS showed a higher pathogen-detection rate than conventional bacterial culture (94.4% vs. 78.1%, P&amp;lt;0.001). In TB-PJI, Mycobacterium tuberculosis complex (MTBC) was detected by mNGS in 17\/19 cases (89.5%) and recovered by mycobacterial culture in 5\/19 cases (26.3%; P&amp;lt;0.001); 12\/19 cases were mNGS-positive\/mycobacterial-culture-negative. In the primary exploratory Firth model, each 1-point increase in CCI was associated with higher odds of TB-PJI (aOR=2.39, 95% CI: 1.51-4.10, P&amp;lt;0.001), whereas each 10% increase in SF PMN% was associated with lower odds (aOR=0.722, 95% CI: 0.564-0.917, P\u00a0=\u00a00.009); BMI was not statistically significant. Drug-related complications were more frequent in TB-PJI (42.1% vs. 11.8%, P\u00a0=\u00a00.002), while the 2-year infection recurrence rate did not differ significantly (15.8% vs. 7.9%, P\u00a0=\u00a00.216).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this selected retrospective cohort, mNGS provided a higher pathogen-detection yield than conventional culture, particularly for TB-PJI. Higher CCI and lower SF PMN% were exploratory clinical associations with TB-PJI and should not be interpreted as validated diagnostic thresholds. mNGS should be considered an adjunct to mycobacterial culture, molecular testing, and histopathology rather than a stand-alone diagnostic test.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1935713","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:52:59Z","timestamp":1791348779000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Metagenomic next-generation sequencing in tuberculous periprosthetic joint infection: pathogen-detection yield and clinical characteristics compared with common bacterial PJI"],"prefix":"10.3389","volume":"16","author":[{"given":"Jiayu","family":"Li","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Orthopedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuntao","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Orthopedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Wuping County Hospital","place":["Longyan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Orthopedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yafei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Orthopedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenbo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Orthopedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zida","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Orthopedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaoyang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Orthopedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Orthopedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenming","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]},{"name":"Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University","place":["Fuzhou, China"]},{"name":"Fujian Orthopedic Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center, The First Affiliated Hospital of Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B2","doi-asserted-by":"publisher","DOI":"10.52965\/001c.138205","article-title":"Periprosthetic joint infection: a multifaceted burden undermining arthroplasty success","volume":"17","author":"Aftab","year":"2025","journal-title":"Orthopedic Rev."},{"key":"B5","doi-asserted-by":"publisher","first-page":"849","DOI":"10.3390\/microorganisms12050849","article-title":"Prosthetic joint infections caused by Mycobacterium tuberculosis complex-an ESGIAI-ESGMYC multicenter, retrospective study and literature review","volume":"12","author":"Au\u00f1on","year":"2024","journal-title":"Microorganisms"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.4325","article-title":"Mycobacterium tuberculosis as a cause of periprosthetic joint infection after total knee arthroplasty: a review of the literature","volume":"11","author":"Bi","year":"2019","journal-title":"Cureus"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2024.1457639","article-title":"Shedding light on negative cultures in osteoarticular infections: leveraging mNGS to unravel risk factors and microbial profiles","volume":"14","author":"Ding","year":"2024","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1654","DOI":"10.3390\/diagnostics12071654","article-title":"Microbiological profiles of patients with periprosthetic joint infection of the hip or knee","volume":"12","author":"Fr\u00f6schen","year":"2022","journal-title":"Diagnostics (Basel Switzerland)"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1488","DOI":"10.1016\/j.arth.2022.01.061","article-title":"Diagnosis and treatment of culture-negative periprosthetic joint infection","volume":"37","author":"Goh","year":"2022","journal-title":"J. Arthroplasty"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2409","DOI":"10.1002\/sim.1047","article-title":"A solution to the problem of separation in logistic regression","volume":"21","author":"Heinze","year":"2002","journal-title":"Stat. Med."},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1686503","article-title":"The application value and challenges of metagenomic next-generation sequencing in the diagnosis of periprosthetic joint infection after arthroplasty","volume":"12","author":"Huang","year":"2025","journal-title":"Front. Med."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/jeo2.70263","article-title":"Molecular diagnostics for perioperative microbial identification in periprosthetic joint infection: a scoping review and proposal of a diagnostic flow chart","volume":"12","author":"Indelli","year":"2025","journal-title":"J. Exp. Orthopaedics"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00402-18","article-title":"Direct detection and identification of prosthetic joint infection pathogens in synovial fluid by metagenomic shotgun sequencing","volume":"56","author":"Ivy","year":"2018","journal-title":"J. Clin. Microbiol."},{"key":"B1","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1302\/2058-5241.4.180092","article-title":"Periprosthetic joint infection: current concepts and outlook","volume":"4","author":"Izakovicova","year":"2019","journal-title":"EFORT Open Rev."},{"key":"B14","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1631\/jzus.b2300029","article-title":"Clinical applications of metagenomics next-generation sequencing in infectious diseases","volume":"25","author":"Liu","year":"2024","journal-title":"J. Zhejiang Univ. Sci. B."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab451","article-title":"Management of Mycobacterium tuberculosis prosthetic joint infection: 2 cases and literature review","volume":"8","author":"Lo","year":"2021","journal-title":"Open Forum Infect. Dis."},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2024.1451398","article-title":"Rising challenges in periprosthetic joint infections: a focus on rare pathogens and their clinical implications","volume":"14","author":"Lyu","year":"2024","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1838","DOI":"10.3390\/jcm12051838","article-title":"Diagnostic role of mNGS in polymicrobial periprosthetic joint infection","volume":"12","author":"Mei","year":"2023","journal-title":"J. Clin. Med."},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2025.117157","article-title":"Tuberculosis-related periprosthetic joint infections: report of eleven cases from a single center","volume":"114","author":"Nazli","year":"2026","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1016\/j.cmi.2025.02.022","article-title":"Diagnostic accuracy of 16S rDNA PCR, multiplex PCR and metagenomic next-generation sequencing in periprosthetic joint infections: a systematic review and meta-analysis","volume":"31","author":"Olearo","year":"2025","journal-title":"Clin. Microbiol. Infection Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis."},{"key":"B6","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1080\/14787210.2025.2536837","article-title":"Clinical treatment of mycobacterial prosthetic joint infections","volume":"23","author":"Ortega-Portas","year":"2025","journal-title":"Expert Rev. Anti-Infective Ther."},{"key":"B25","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/cis803","article-title":"Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America","volume":"56","author":"Osmon","year":"2013","journal-title":"Clin. Infect. Dis. An. Off. Publ. Infect. Dis. Soc. America"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1016\/j.arth.2018.02.078","article-title":"The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria","volume":"33","author":"Parvizi","year":"2018","journal-title":"J. Arthroplasty"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-024-04745-5","article-title":"Clinical applications of metagenomic next-generation sequencing in the identification of pathogens in periprosthetic joint infections: a retrospective study","volume":"19","author":"Shi","year":"2024","journal-title":"J. Orthopaedic Surg. Res."},{"key":"B16","doi-asserted-by":"publisher","first-page":"2334","DOI":"10.1128\/jcm.00462-17","article-title":"Molecular diagnosis of orthopedic-device-related infection directly from sonication fluid by metagenomic sequencing","volume":"55","author":"Street","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1951","DOI":"10.2147\/idr.s441940","article-title":"Diagnostic role of metagenomic next-generation sequencing in tubercular orthopedic implant-associated infection","volume":"17","author":"Wang","year":"2024","journal-title":"Infection Drug Resistance"},{"key":"B18","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1186\/s12879-020-04955-2","article-title":"Can metagenomic next-generation sequencing identify the pathogens responsible for culture-negative prosthetic joint infection","volume":"20","author":"Wang","year":"2020","journal-title":"BMC Infect. Dis."},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2024.1388385","article-title":"Improved cure rate of periprosthetic joint infection through targeted antibiotic therapy based on integrated pathogen diagnosis strategy","volume":"14","author":"Wang","year":"2024","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2024.1458316","article-title":"Application of metagenomic next-generation sequencing in the diagnosis of infectious diseases","volume":"14","author":"Zhao","year":"2024","journal-title":"Front. Cell. Infect. Microbiol."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1935713\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:53:05Z","timestamp":1791348785000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1935713\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":26,"alternative-id":["10.3389\/fcimb.2026.1935713"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1935713","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]},"article-number":"1935713"}}