Next-generation sequencing for diagnosing primary osteoarticular infections compared to conventional culture: A systematic review and meta-analysis

Background Osteoarticular infections (OAIs) in children is a significant diagnostic challenge for healthcare professionals. Traditional culture techniques are often time consuming and demonstrated low sensitivity. This systematic review aims to evaluate the diagnostic yield of metagenomic Next Generation Sequencing (mNGS) compared to standard culture for detecting pathogens in OAIs. Methods A systematic review (PROSPERO CRD420251131272) of three databases (2000-2025) was performed. Study quality was assessed using the QUADAS-2 tool. A meta-analysis was performed using a random-effects model to calculate pooled positive detection rate with 95% confidence intervals (95%CI). Heterogeneity was quantified (I 2 ), and sensitivity analysis with leave-one-out and subgroups were performed. Findings From 35 included studies (>3000 patients), mNGS demonstrated a significantly higher pooled positive detection rate (81%; 95%CI:75 to 85%) than traditional culture (35%; 95%CI:29 to 41%) with high heterogeneity (>80%). mNGS performed consistently in pediatric (79%) and adult (81%) subgroups and was particularly effective for spinal infections (82%). Interpretation The mNGS demonstrates a significantly higher diagnostic yield than standard culture for pathogen detection in osteoarticular infections. Its simplicity of execution, its fast-processing methods and high sensitivity, are promising factors that could lead to a more reliable detection of the causative microorganism responsible for an osteoarticular infection.