Diagnostic accuracy and clinical considerations of metagenomic next-generation sequencing in prosthetic joint infection: a systematic review and meta-analysis
In brief
Metagenomic sequencing detects 18 percentage points more prosthetic joint infections than culture
Across 14 studies and 1,579 cases, metagenomic sequencing had 84% sensitivity for prosthetic joint infection, compared with 66% for conventional culture. Its specificity was lower, at 92% versus 96%, and overall diagnostic performance was comparable; sequencing may complement culture, but organisms it alone detects need cautious interpretation alongside clinical findings.
- Journal
- European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (Q1)
- Published
- 23 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Neža Trebše, Sara Hyvärinen, Robert Šket, Jernej Kovač, Rihard Trebše, Marko Pokorn
- PMID
- 42918922
- DOI
- 10.1007/s10096-026-05701-3
Why clinicians should know about it
- Picked for Microbiology (medical) (paper of the day, 24 October 2026): Diagnostic-accuracy meta-analysis comparing mNGS with culture
Abstract
PURPOSE: Metagenomic next-generation sequencing (mNGS) has emerged as a promising complementary method for pathogen detection in prosthetic joint infection (PJI). This systematic review and meta-analysis evaluated the diagnostic accuracy of mNGS and conventional microbiological culture. METHODS: A systematic review and bivariate diagnostic accuracy meta-analysis were conducted in accordance with the PRISMA-DTA guidelines. PubMed, Ovid MEDLINE, Embase, WoS and the CNKI database were searched. Eligible studies evaluated shotgun mNGS in suspected or confirmed PJI, used a recognized reference standard for diagnosis, and reported sufficient data to construct 2 × 2 contingency tables for mNGS and conventional culture. Pooled sensitivity and specificity were estimated using a bivariate random-effects Reitsma model. RESULTS: Fourteen studies comprising 1,579 cases were included, of which 982 were classified as PJI and 597 as non-PJI. When pooled separately, mNGS had a sensitivity of 84.3% (95% CI 77.3-89.4%) and specificity of 91.5% (95% CI 88.4-93.9%), compared with 66.0% (95% CI 60.1-71.4%) and 95.6% (95% CI 92.8-97.4%), respectively, for conventional culture. The area under the summary receiver operating characteristic (SROC) curve was 0.941 for mNGS and 0.930 for culture. Sensitivity analyses did not change the overall findings. CONCLUSION: When analysed separately, mNGS demonstrated higher pooled sensitivity than conventional culture. Overall diagnostic performance assessed by SROC was comparable between the two methods. These findings suggest that mNGS may provide complementary microbiological information. Nevertheless, microorganisms detected exclusively by mNGS should be interpreted cautiously and in conjunction with other clinical and laboratory findings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.