宏基因组下一代测序在诊断原发性化脓性脊柱感染中的价值：一项多中心回顾性观察研究

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

作者信息

Li Zhaohui, Zhang Qiang, Lian Xiaofeng, Yin Chuqiang, Lin Yuhan, Wang Yuelei, Han Zengshuai, Shen Feng, Xu Yidan, Wang Huafeng, Wang Ting

机构信息

Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Shandong, China.

Orthopedics Section II (Bone Infection), Public Health Clinical Center Affiliated to Shandong University, Shangdong, China.

出版信息

Spine J. 2025 Apr;25(4):640-648. doi: 10.1016/j.spinee.2024.11.004. Epub 2024 Nov 29.

DOI:10.1016/j.spinee.2024.11.004

PMID:39615696

Abstract

BACKGROUND CONTEXT

The 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.

PURPOSE

Comparing mNGS with microbial culture to comprehensively explore the diagnostic value of mNGS in pyogenic spinal infections.

DESIGN

A multicenter, retrospective observational study.

PATIENT SAMPLE

In a multicenter retrospective observational study, we analyzed the data from 301 patients admitted in four selected hospitals with pyogenic spinal infections from December 2019 to February 2024.

OUTCOME MEASURES

Identification of pathogenic bacteria in patients.

METHODS

Obtain 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.

RESULTS

In 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<.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).

CONCLUSIONS

mNGS serves as a valuable supplement to the culture method and shows potential in identifying the causative pathogen in native pyogenic spinal infections.

摘要

背景

化脓性脊柱感染的病因诊断对精准的抗生素治疗至关重要。传统检测方法往往缓慢且低效。近年来，宏基因组下一代测序（mNGS）彻底改变了病原体检测方式，为疾病管理提供了更有效的方法。

目的

比较mNGS与微生物培养，全面探讨mNGS在化脓性脊柱感染中的诊断价值。

设计

多中心回顾性观察研究。

患者样本

在一项多中心回顾性观察研究中，我们分析了2019年12月至2024年2月期间在四家选定医院收治的301例化脓性脊柱感染患者的数据。

观察指标

确定患者体内的病原菌。

方法

从入组患者获取血液、病变组织或脓液样本，进行微生物培养、血清学和血液学实验室检查、病理检查及mNGS分析，随后对结果进行比较分析。

结果

在我们301例临床诊断为化脓性脊柱感染的队列中，242例获得了病因学证据。最常见的革兰氏阳性菌是金黄色葡萄球菌，最常见的革兰氏阴性菌是大肠杆菌。mNGS的检出率（77.9%）显著高于微生物培养（27.2%），差异有统计学意义（X² = 140.17，P <.001）。在培养阴性样本中，mNGS能在73.1%的病例中检测到病原体；在培养阳性样本中，能在91.5%的病例中检测到病原体，属水平一致性为94.7%。与培养方法（2 - 7天）相比，mNGS出结果更快（24 - 48小时）。