Shotgun Metatranscriptomics for PJI diagnosis: A Novel Prospective Investigation

While metagenomic (microbial DNA) sequencing technologies can detect the presence of microbes in a clinical sample, it is unknown whether this signal represents dead or live organisms within a microbial community, and also if it maps expressed genes to a functional pathway of interest (e.g. antibiotic resistance.) After RNA metratranscriptomic analysis of synovial fluid and peripheral blood, differential metatranscrptomic signatures for infected vs. noninfected cohorts enabled us to train machine learning algorithms to 84.9% predictive accuracy for infection. A variety of antibiotic resistance genes were also expressed, with high concordance to conventional antibiotic sensitivity data.