Pathogenic detection by metagenomic next-generation sequencing in spinal infections

English Keywords:Spinal infection  Metagenomic  Next-generation sequencing  Pathogens

English Abstract:

  【Abstract】 Objectives: To evaluate the application and value of metagenomic next-generation sequencing (mNGS) in detecting pathogens from spinal infections. Methods: 46 samples were prospectively collected from patients who were suspected spinal infections and treated from January 2019 to December 2020. There were 26 males and 20 females, with an average age of 50.4±15.7 years(26-77 years). Blood and focal tissue or pus samples were obtained(21 samples were from CT guided biopsy while 25 samples from open surgery). Microbial culture, serological testing, pathological examination and mNGS were performed and compared pairwise in all cases. Results: All results of mNGS were obtained within 48 hours, and the traditional laboratory tests ranged from 1 to 12 days. Of all 46 cases, 35 were diagnosed as spinal infection and 11 cases as non-infection. 23 cases were found with microbiology evidence, including pyogenic infection(14 cases), tuberculosis(5 cases) and brucella(4 cases) infection. Still, 12 cases were clinically diagnosed as spinal infection without clear microbiology evidence. 11 cases were non-infection, including spine tumor(3 cases), endplate Modic change(4 cases), endplate fracture(1 case), Dish disease with pseudoarthrosis(1 case) and ankylosing spondylitis with pseudoarthrosis(2 cases). Rare microorganisms such as Bacteroides fragilis, Parvimonas micra, Treponema denticola and Coxiella burnetii were detected by mNGS. At the species level, the consistency between mNGS and the final clinical diagnosis was 82.61%(19/23), while that of mNGS reached 95.65%(22/23) at the genus level. The positive rate of mNGS was 94.29%(33/35), significantly higher than that of microbiological culture, which had a positive rate of 42.86%(15/35), P<0.01. The sensitivity, specificity, positive predictive value and negative predictive value of mNGS were 91.43%, 90.91%, 96.97% and 76.92%, respectively. Conclusions: mNGS is a fast, efficient and accurate diagnostic tool for pathogenic detection. It has high diagnostic and application value in the diagnosis and treatment of spinal infection diseases.