Spinal infections? mNGS combined with microculture and pathology for answers

Abstract

Abstract Background This study focuses on the efficacy of genome sequencing technology (mNGS) in diagnosing infections of the spine and the development of therapeutic regimens combining mNGS, microbiological cultures, and pathological investigations to provide new perspectives for the treatment of spinal infections. Methods Data were collected on 108 patients with suspected spinal infections between January 2022 and December 2023. Lesion tissues were obtained through C-arm assisted puncture or open surgery for mNGS, conventional microbiological culture, or pathological analysis. Treatment plans involving personalized antimicrobial therapy were tailored based on mNGS findings, microbial cultures, and pathological analysis, with a follow-up evaluation 7 days postoperatively. The sensitivity and specificity of mNGS for detecting spinal infection pathogens, as well as its impact on treatment and prognosis, were assessed based on the final clinical outcomes. Results In the diagnosis of spinal infections, the positive detection rate of mNGS (61.20%) was significantly higher than that of conventional microbiological culture (30.80%) and PCT (28%). The sensitivity (79.41%) and negative predictive value (63.16%) of mNGS were substantially greater than those of cultures (25% and 22.58%, respectively), with no significant difference in specificity and positive predictive value. Seven days post-surgery, a notable reduction in the percentage of neutrophils (NEUT%) was observed, while decreases in white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were not statistically significant. At the last follow-up, there was a significant decrease in all patients' Visual Analogue Scale (VAS) scores, Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores. Conclusion The efficacy of mNGS technology surpasses traditional microbiological culture in pathogen detection, exhibiting superior performance particularly in identifying rare and critical pathogens. Treatment protocols combining mNGS, microbiological cultures and pathological examinations are effective in the treatment of spinal infections and provide a valuable clinical reference.