疑似脊柱感染病原体检测：宏基因组下一代测序与培养比较。
Pathogen detection in suspected spinal infection: metagenomic next-generation sequencing versus culture.
机构信息
Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Orthopaedic Surgery, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, China.
出版信息
Eur Spine J. 2023 Dec;32(12):4220-4228. doi: 10.1007/s00586-023-07707-3. Epub 2023 May 26.
PURPOSE
The aim is to compare the pathogen detection performance of metagenomic next-generation sequencing (mNGS) and the culturing of percutaneous needle biopsy samples obtained from an individual with a suspected spinal infection.
METHODS
A retrospective study of 141 individuals with a suspected spinal infection was conducted, and mNGS was performed. The microbial spectra and detection performance between mNGS and the culturing-based method were compared, and the effects of antibiotic intervention and biopsy on the detection performance were assessed.
RESULTS
The microorganisms isolated most commonly via the culturing-based method were Mycobacterium tuberculosis (n = 21), followed by Staphylococcus epidermidis (n = 13). The most common microorganisms detected via mNGS were Mycobacterium tuberculosis complex (MTBC) (n = 39), followed by Staphylococcus aureus (n = 15). The difference in the type of detected microorganisms between culturing and mNGS was observed only in Mycobacterium (P = 0.001). mNGS helped identify potential pathogens in 80.9% of cases, which was significantly higher than the positivity rate of 59.6% observed for the culturing-based method (P < 0.001). Moreover, mNGS had a sensitivity of 85.7% (95% CI, 78.4% to 91.3%), a specificity of 86.7% (95% CI, 59.5% to 98.3%), and sensitivity gains of 35% (85.7% vs. 50.8%; P < 0.001) during culturing, while no differences were observed in the specificity (86.7% vs. 93.3%; P = 0.543). In addition, antibiotic interventions significantly lowered the positivity rate of the culturing-based method (66.0% vs. 45.5%, P = 0.021) but had no effects on the results of mNGS (82.5% vs. 77.3%, P = 0.467).
CONCLUSION
The use of mNGS could result in a higher detection rate compared to that observed with the culturing-based method in an individual with spinal infection and is particularly valuable for evaluating the effects of a mycobacterial infection or previous antibiotic intervention.
目的
比较宏基因组下一代测序（mNGS）与经皮穿刺活检样本培养在诊断疑似脊柱感染患者中的病原体检测性能。
方法
回顾性分析了 141 例疑似脊柱感染患者的临床资料，所有患者均进行 mNGS 检测，比较 mNGS 与培养法的微生物谱和检测性能，并评估抗生素干预和活检对检测性能的影响。
结果
培养法最常分离的微生物为结核分枝杆菌（n=21），其次为表皮葡萄球菌（n=13）。mNGS 最常检测到的微生物为结核分枝杆菌复合群（n=39），其次为金黄色葡萄球菌（n=15）。培养和 mNGS 检测到的微生物类型仅在分枝杆菌中存在差异（P=0.001）。mNGS 可帮助确定 80.9%（80.9%）的疑似脊柱感染患者的潜在病原体，显著高于培养法的阳性率（59.6%）（P<0.001）。此外，mNGS 的敏感性为 85.7%（95%CI，78.4%至 91.3%），特异性为 86.7%（95%CI，59.5%至 98.3%），与培养法相比，敏感性提高了 35%（85.7%比 50.8%；P<0.001），但特异性无差异（86.7%比 93.3%；P=0.543）。此外，抗生素干预显著降低了培养法的阳性率（66.0%比 45.5%，P=0.021），但对 mNGS 无影响（82.5%比 77.3%，P=0.467）。
结论
与培养法相比，mNGS 可提高疑似脊柱感染患者的检测率，尤其对评估分枝杆菌感染或既往抗生素干预的效果有价值。
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