Application of next-generation metagenomic sequencing in the diagnosis and treatment of acute spinal infections

Objectives: The purpose of this study was to verify the value of metagenomic next-generation sequencing (mNGS) in detecting the pathogens causing acute spinal infection by reviewing the results of mNGS in 114 patients.Methods: A total of 114 patients were included from our hospital. Samples (tissue/blood) were sent for mNGS detection, and the remaining samples were sent to the microbiology laboratory for pathogen culture, smear, histopathological analysis, and other tests. Patients' medical records were reviewed to determine their rates of detection, time needed, guidance for antibiotic treat-ment and clinical outcomes.Results: mNGS showed a satisfying diagnostic positive percent agreement of 84.91% (95% con-fidence interval (CI): 6.34%-96.7%), compared to 30.19% (95% CI: 21.85%-39.99%) for culture and 43.40% (95% CI: 31.39%-49.97%) for conventional methods (p < 0.0125), and mNGS was found positive in 46 culture and smear negative samples. The time required for pathogen iden-tification using mNGS ranged from 29 h to 53 h, which showed an advantage over culture (90.88 +/- 8.33 h; P < 0.05). mNGS also played an important role in optimizing antibiotic regimens in patients with negative results obtained using conventional methods. The treatment success rate (TSR) of patients using mNGS-guided antibiotic regimens (20/24, 83.33%) was significantly higher than that of patients using empirical antibiotics (13/23, 56.52%) (P < 0.0001).Conclusions: mNGS shows promising potential in the pathogenic diagnosis of acute spinal in-fections and may enable clinicians to make more timely and effective adjustments to antibiotic regimens.