Clinical application value of metagenomic next-generation sequencing in the diagnosis of spinal infections and its impact on clinical outcomes

Abstract

This study aimed to evaluate the impact of precise treatment administered according to the results of metagenomic next-generation sequencing (mNGS) on the clinical outcomes of patients with spinal infections. In this multicenter retrospective study, the clinical data of 158 patients with spinal infections who were admitted to Xiangya Hospital Central South University, Xiangya Boai Rehabilitation Hospital, The First Hospital of Changsha, and Hunan Chest Hospital from 2017 to 2022 were reviewed. Among these 158 patients, 80 patients were treated with targeted antibiotics according to the mNGS results and were assigned to the targeted medicine (TM) group. The remaining 78 patients with negative mNGS results and those without mNGS and negative microbial culture results were treated with empirical antibiotics and assigned to the empirical drug (EM) group. The impact of targeted antibiotics based on the mNGS results on the clinical outcomes of patients with spinal infections in the two groups was analyzed. The positive rate of mNGS for diagnosing spinal infections was significantly higher than that of microbiological culture (X2=83.92, P<0.001), procalcitonin (X2=44.34, P<0.001), white blood cells (X2=89.21, P < 0.001), and IGRAs (Interferon-gamma Release Tests) (X2 = 41.50, P < 0.001). After surgery, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) showed a decreasing trend in the patients with spinal infections in both the TM and EM groups. The decrease in CRP was more obvious in the TM group than in the EM group at 7, 14 days, 3, and 6 months after surgery (P<0.05). The decrease in ESR was also significantly obvious in the TM group compared with the EM group at 1 and 6 months after surgery (P<0.05). The time taken for CRP and ESR to return to normal in the TM group was significantly shorter than that in the EM group (P<0.05). There was no significant difference in the incidence of poor postoperative outcomes between the two groups. The positive rate of mNGS for the diagnosis of spinal infection is significantly higher than that of traditional detection methods. The use of targeted antibiotics based on mNGS results could enable patients with spinal infections to achieve a faster clinical cure.

Evaluation of different methods in diagnosis of spinal tuberculosis infection

“…Those two patients diagnosed with fungal infections were identi ed by mNGS as Aspergillus fumigatus and Aspergillus mirabilis. Aspergillus fumigis has been reported to be the main species detected in Aspergillus [22] .It is di cult to distinguish between multiple pathogens clinically, and the number of patients suspected of spinal tuberculosis in hospitals is gradually increasing, mNGS can detect almost all clinical pathogens and can provide pathogen information and even discover new pathogens [19] .And targeted antibiotic therapy based on mNGS results has achieved certain results [23] .And mNGS testing is less affected by antibiotics [24] .In a smear test of an extrapulmonary tuberculosis sample, mNGS can immediately identify all possible pathogens within 48 hours [8] .In previous studies, mNGS performed well in a variety of suspected infectious diseases [18][25] .However, the ability to discriminate from suspected spinal TB infection has been poorly reported [19] .…”

Identification of Mycobacterium tuberculosis Resistance to Common Antibiotics: An Overview of Current Methods and Techniques

“… 76 , 77 Metagenomic next-generation sequencing (NGS) detected MTB with high specificity and sensitivity but overlooked the drug resistance information. 78 , 79 Then, targeted next-generation sequencing (NGS) may be an early detection method for drug resistance directly from MTBC-positive specimens, with the resistance mutations by 100%. The turnaround time of the tNGS assay showed less than culture and Whole Genome Sequencing (WGS) workflows with a two-week and a similar cost.…”

Diagnostic Performance of Central Nervous System Infections in Patients With Neurosurgical Intensive Care Using Metagenomic Next-Generation Sequencing: A Prospective Observational Study

“…Metagenomics is an emerging technology for pathogen detection. It can be scaled up for high-throughput database matching, raw letter analysis, and all-in detection of pathogens such as bacteria, fungi, viruses, and parasites (10)(11)(12)(13)(14)(15). It has been recognized as an emerging diagnostic method applicable to various specimen types (16)(17)(18)(19), including blood, bronchoalveolar lavage fluid, sputum, and urine (20)(21)(22).…”