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已发表论文
抗生素暴露持续时间对假体周围关节感染病原体检测的影响
Authors Lin L, You W, Liao Y , Wu B, Lin H, Huang Z, Zeng J, Zhang Z, Huang C, Li W, Fang X
Received 25 July 2025
Accepted for publication 16 October 2025
Published 4 November 2025 Volume 2025:18 Pages 5661—5670
DOI https://doi.org/10.2147/IDR.S555992
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Oliver Planz
Lan Lin,1– 3,* Wenkang You,1– 3,* Yuntao Liao,1– 3,* Baijian Wu,1– 3,* Huangfeng Lin,1– 3 Zida Huang,1– 3 Jinyuan Zeng,1– 3 Zeyu Zhang,1– 3 Chengguo Huang,4 Wenbo Li,1– 3 Xinyu Fang1– 3
1Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China; 2Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China; 3Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China; 4Department of Orthopaedic Surgery, Pingnan County Hospital, Ningde, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xinyu Fang; Wenbo Li, Email fangxinyu0417@fjmu.edu.cn; liwenbo350001@163.com
Objective: Antibiotic exposure affects pathogen detection in periprosthetic joint infection (PJI). This study evaluated the impact of antibiotic duration before sampling on the diagnostic performance of microbiological cultures and metagenomic next-generation sequencing (mNGS).
Methods: We conducted a retrospective analysis of 153 patients with PJI treated at our center between January 2013 and March 2024. Patients who had discontinued antibiotics for at least 7 days before sampling and those with no history of antibiotic use were classified into the antibiotic-withdrawal group (AWD group). Based on the duration of antibiotic exposure, those who received antibiotics for ≤ 7 days before sampling was assigned to the short-term antibiotic group (STA group), while those with > 7 days of continuous antibiotic use were included in the long-term antibiotic group (LTA group). By comparing microbiological culture and mNGS results across these groups, we analyzed how antibiotic duration before sampling affects etiological diagnosis in PJI patients.
Results: In the AWD group, microbial culture positivity (86.3%, 44/51) was comparable to mNGS (92.2%, 47/51; P=0.338). However, mNGS demonstrated superior positivity rates in both the STA (86.7% vs 70.0%, P=0.027) and LTA groups (76.2% vs 54.8%, P=0.039). Prolonged antibiotic use (> 7 days) markedly reduced culture positivity (86.3% to 54.8%, P=0.001), whereas the decline in mNGS sensitivity was smaller (92.2% to 76.2%, P=0.032), indicating its greater resistance to antibiotic effects. Among culture-negative PJI cases, mNGS maintained robust diagnostic performance across all groups (CN-AWD: 57.1%; CN-STA: 66.7%; CN-LTA: 57.9%), with no significant differences observed.
Conclusion: Antibiotic use before sampling significantly impacts PJI pathogen detection. We recommend either: (1) sampling after ≥ 7 days without antibiotics, or (2) for patients on prolonged antibiotics (> 7 days), combining microbial culture with routine mNGS to improve diagnostic accuracy.
Keywords: periprosthetic joint infection, microbiological cultures, metagenomic next-generation sequencing, prior use of antibiotics, pathogen diagnosis
1Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China; 2Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, People’s Republic of China; 3Fujian Provincial Institute of Orthopedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China; 4Department of Orthopaedic Surgery, Pingnan County Hospital, Ningde, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xinyu Fang; Wenbo Li, Email fangxinyu0417@fjmu.edu.cn; liwenbo350001@163.com
Objective: Antibiotic exposure affects pathogen detection in periprosthetic joint infection (PJI). This study evaluated the impact of antibiotic duration before sampling on the diagnostic performance of microbiological cultures and metagenomic next-generation sequencing (mNGS).
Methods: We conducted a retrospective analysis of 153 patients with PJI treated at our center between January 2013 and March 2024. Patients who had discontinued antibiotics for at least 7 days before sampling and those with no history of antibiotic use were classified into the antibiotic-withdrawal group (AWD group). Based on the duration of antibiotic exposure, those who received antibiotics for ≤ 7 days before sampling was assigned to the short-term antibiotic group (STA group), while those with > 7 days of continuous antibiotic use were included in the long-term antibiotic group (LTA group). By comparing microbiological culture and mNGS results across these groups, we analyzed how antibiotic duration before sampling affects etiological diagnosis in PJI patients.
Results: In the AWD group, microbial culture positivity (86.3%, 44/51) was comparable to mNGS (92.2%, 47/51; P=0.338). However, mNGS demonstrated superior positivity rates in both the STA (86.7% vs 70.0%, P=0.027) and LTA groups (76.2% vs 54.8%, P=0.039). Prolonged antibiotic use (> 7 days) markedly reduced culture positivity (86.3% to 54.8%, P=0.001), whereas the decline in mNGS sensitivity was smaller (92.2% to 76.2%, P=0.032), indicating its greater resistance to antibiotic effects. Among culture-negative PJI cases, mNGS maintained robust diagnostic performance across all groups (CN-AWD: 57.1%; CN-STA: 66.7%; CN-LTA: 57.9%), with no significant differences observed.
Conclusion: Antibiotic use before sampling significantly impacts PJI pathogen detection. We recommend either: (1) sampling after ≥ 7 days without antibiotics, or (2) for patients on prolonged antibiotics (> 7 days), combining microbial culture with routine mNGS to improve diagnostic accuracy.
Keywords: periprosthetic joint infection, microbiological cultures, metagenomic next-generation sequencing, prior use of antibiotics, pathogen diagnosis