Value of metagenomic next-generation sequencing in the diagnosis of native pyogenic spinal infections: a multicenter, retrospective observational study

Abstract

Background contextThe etiological diagnosis of pyogenic spinal infection is crucial for its precise antibiotic treatment. Traditional methods of detection are often slow and ineffective. In recent times, metagenomic next-generation sequencing (mNGS) has revolutionized pathogen detection, offering a more effective approach to disease management. PurposeComparing mNGS with microbial culture to comprehensively explore the diagnostic value of mNGS in pyogenic spinal infections. DesignA multicenter, retrospective observational study. Patient sampleIn a multicenter retrospective observational study, we analyzed the data from 301 patients admitted in 4 selected hospitals with pyogenic spinal infections from December 2019 to February 2024. Outcome measuresIdentification of pathogenic bacteria in patients. MethodsObtain blood and lesion tissue or pus samples from the enrolled patients for microbial culture, serological and hematological laboratory tests, pathological examination, and mNGS analysis, followed by a comparative analysis of the results. ResultsIn our cohort of 301 cases of clinically diagnosed pyogenic spinal infections, 242 yielded etiological evidence. The most common gram-positive bacterium was Staphylococcus aureus, and the most common gram-negative bacterium was Escherichia coli. mNGS showed a significantly higher rate of detection (77.9%) compared with microbial culture (27.2%) with a notable difference (X² = 140.17, P < 0.001). In culture-negative samples, mNGS could detect pathogens in 73.1% of cases, and in culture-positive samples, it could detect pathogens in 91.5% of cases with 94.7% genus-level concordance. mNGS provided faster results (24–48 h) compared with the culture method (2–7 days). ConclusionsmNGS serves as a valuable supplement to the culture method and shows potential in identifying the causative pathogen in native pyogenic spinal infections.