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Review
. 2023 Dec;32(12):4220-4228.
doi: 10.1007/s00586-023-07707-3. Epub 2023 May 26.

Pathogen detection in suspected spinal infection: metagenomic next-generation sequencing versus culture

Haihong Huang  1 , Jiawei Shi  1 , Minghui Zheng  1   2 , Shenghui Su  1 , Weidong Chen  1 , Jing Ming  3 , Tao Ren  2 , Dongbin Qu  4   5
Affiliations
Review

Pathogen detection in suspected spinal infection: metagenomic next-generation sequencing versus culture

Haihong Huang et al. Eur Spine J. 2023 Dec.

Abstract

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.

Keywords: Culture; Diagnosis; Metagenomic next-generation sequencing; Pathogen; Percutaneous needle biopsy; Spinal infection.

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References

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