Comparative study of culture, next-generation sequencing, and immunoassay for identification of pathogen in diabetic foot ulcer.
Comparative study of culture, next-generation sequencing, and immunoassay for identification of pathogen in diabetic foot ulcer.
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DOI：
10.1002/jor.25001
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Oh I
中科院分区：
文献类型：
--
作者：
Lipof JS;Jones CMC;Daiss J;Oh I
深部肌肉骨骼感染（MSKI）的治疗首先要准确识别致病病原体，手术切除/清创，以及一个疗程的培养导向抗生素。尽管如此，复发性感染的发生率继续上升。造成这种情况的一个主要原因是不准确或阴性的初始培养物。准确识别主要病原体对治疗成功至关重要。这在通过保肢治疗糖尿病足感染（DFI）时尤为重要。本研究旨在利用标准培养（SC），下一代测序（NGS）和免疫测定新合成的抗体（NSA）的金黄色葡萄球菌和无乳链球菌的诊断。这是一项经我们IRB批准的II级前瞻性观察性研究。入组年龄>18岁的I型或II型糖尿病患者，这些患者患有DFI，并在2018年10月至2019年9月期间由一名学术骨科医生进行手术清创或截肢，用于DFI。从伤口底部获得术中样本，并在诊断时进行培养、NGS和外周血样本。30例DFI患者接受了干预并入组。NGS和SC与金黄色葡萄球菌（K=0.86）和GBS（K=1.0）高度相关，NSA和培养与金黄色葡萄球菌（K=0.18）和GBS（K=0.67）具有中等相关性，NGS和NSA与金黄色葡萄球菌（K=0.1667）和GBS（K=0.67）具有中等相关性。临床意义声明-我们的研究证明了DFU中培养和NGS之间的高度一致性。NGS可作为DFI诊断的辅助手段。关键词：新一代测序，免疫测定，MENSA，糖尿病足溃疡
Treatment of deep musculoskeletal infection (MSKI) begins with accurate identification of the offending pathogen, surgical excision/debridement, and a course of culture-directed antibiotics. Despite this, the incidence of recurrent infection continues to rise. A major contributor to this is inaccurate or negative initial cultures. Accurate identification of the main pathogen is paramount to treatment success. This is especially important in treating diabetic foot infections (DFI) with limb salvage efforts. This study seeks to utilize standard culture (SC), Next-Generation Sequencing (NGS) and immunoassay for newly synthesized antibodies (NSA) to S aureas and S agalactiae for diagnosis. This was a level II prospective observational study approved by our IRB. Type I or II Diabetes patients >18 years of age were enrolled who presented with a DFI and underwent surgical debridement or amputation by a single academic orthopedic surgeon from October 2018 to September 2019 for DFI Intraoperative samples were obtained from the base of the wound and sent for culture, NGS and a peripheral blood sample was obtained at the time of diagnosis. Thirty DFI patients underwent intervention and were enrolled. NGS and SC were highly correlated for S aureas (K=0.86) and GBS (K=1.0), NSA and culture demonstrated a fair correlation for S aureas (K=0.18) and GBS (K=0.67), and NGS and NSA demonstrated fair correlation for S aureas (K=0.1667) and GBS (K=0.67). Statement of Clinical Significance -Our study demonstrates high-concordance between culture and NGS in DFU. NGS may be a useful adjunct in DFI diagnosis. Keywords: next-generation sequencing, immunoassay, MENSA, Diabetic Foot Ulcer
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