# Combination of laboratory automation and next-generation sequencing for the diagnosis of osteoarticular infections: a technical note

## TL;DR

This paper introduces a new diagnostic workflow combining automation and sequencing to improve detection of pathogens in osteoarticular infections.

## Contribution

A sequential workflow integrating laboratory automation, broth enrichment, and NGS for diagnosing osteoarticular infections is presented.

## Key findings

- Laboratory automation identified pathogens in 42% of cases.
- Broth enrichment and NGS added identifications in 23% and 11.5% of LA-negative cases.
- The workflow provided results within 10 days and improved detection in culture-negative cases.

## Abstract

Osteoarticular infections (OAIs) present a diagnostic challenge, particularly when conventional cultures fail to identify the causative pathogen. We developed and implemented a sequential diagnostic workflow for intraoperative orthopaedic tissue samples, integrating laboratory automation (LA), broth enrichment, and next-generation sequencing (NGS). Between September 2023 and March 2025, 702 samples from 117 patients with suspected OAIs were processed. LA identified pathogens in 42% of cases. Among LA-negative patients, broth enrichment and NGS yielded additional identifications in 23% and 11.5% of cases, respectively. Our workflow achieved a diagnostic result within 10 days while improving detection rates, particularly in culture-negative cases. Our experience demonstrates that combining advanced microbiology tools is feasible in the context of suspected OAIs. A multidisciplinary evaluation of results remains essential for optimal patient management.