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In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
The clinical application of metagenomic next-generation sequencing in pathogen identification of postoperative spinal
Tengfei Shi1, Shaohan Xu2, Yuhan Lin3
1Department of Clinical Laboratory, Fuzhou Second General Hospital, Fuzhou, Fujian, China.
Background Context:
Postoperative spinal implant infection (PSII) poses significant diagnostic challenges and can lead to serious clinical outcomes. Traditional microbial culture methods are limited by prolonged turnaround times and low sensitivity, which have long hindered a comprehensive understanding of the pathogen spectrum in PSII. Metagenomic next-generation sequencing (mNGS) offers rapid, broad-spectrum, and highly sensitive pathogen detection, providing a promising solution to the diagnostic difficulties associated with PSII.
Purpose:
This study aimed to evaluate the clinical utility of mNGS for the pathogenic diagnosis of PSII.
Study Design/Setting:
Retrospective cohort study.
Patient Sample:
A retrospective analysis was conducted on clinical data from 122 patients with suspected surgical site infection following spinal implant-related surgery between January 2020 and July 2025.
Outcome Measures:
Identification of pathogenic bacteria in patients.
Methods:
According to the National Healthcare Safety Network (NHSN) criteria, patients were classified into the PSII group (n=89) and the nonPSII group (n=33). Pathogen spectrum characteristics of PSII detected by mNGS were analyzed, and the diagnostic performance of mNGS was compared with that of traditional microbial culture, laboratory tests, and imaging studies.
Results:
The pathogen detection rate of mNGS was significantly higher than that of traditional culture (79.78% vs 38.20%, p <.001). mNGS successfully detected pathogens in 42.70% (38/89) of culture-negative PSII cases. The main pathogens identified by mNGS included Staphylococcus aureus and coagulase-negative staphylococci (20.00% each, 15/75), Mycobacterium tuberculosis (18.67%, 14/75), and anaerobic bacteria (14.67%, 11/75). Among the 33 patients positive by both mNGS and culture, species-level concordance was 69.70%. No significant difference in the distribution of major pathogens was observed between early-onset (≤3 months) and late-onset (>3 months) infection groups. Antibiotic appropriateness evaluation revealed that only 32.58% (29/89) of patients had initial antibiotic regimens that provided complete coverage against the detected pathogens. The overall diagnostic performance of mNGS for PSII was superior to that of culture, with significantly higher sensitivity (79.78% vs 38.20%), specificity (100.00% vs 93.94%), positive predictive value (100.00% vs 94.44%), negative predictive value (64.71% vs 36.05%), accuracy (85.25% vs 53.28%), and AUC (0.8989 vs 0.6607).
Conclusion:
mNGS significantly improves the detection of difficult-to-culture pathogens such as M. tuberculosis and anaerobic bacteria in PSII. It is recommended to combine mNGS with conventional methods, thereby improving diagnostic accuracy, guiding rational antibiotic use, and enhancing treatment outcomes.
Insights
Metagenomic next-generation sequencing (mNGS) significantly improves the detection of pathogens in postoperative spinal implant infections (PSII) compared to traditional methods. Combining mNGS with conventional techniques enhances diagnostic accuracy and guides appropriate antibiotic use for better patient outcomes.
Area of Science:
- Infectious Diseases
- Microbiology
- Genomics
- Spinal Surgery
Background:
- Postoperative spinal implant infection (PSII) presents diagnostic challenges due to limitations of traditional microbial cultures, including slow turnaround times and low sensitivity.
- Metagenomic next-generation sequencing (mNGS) offers a rapid, sensitive, and broad-spectrum approach for pathogen detection, addressing diagnostic difficulties in PSII.
Purpose of the Study:
- To evaluate the clinical utility and diagnostic performance of mNGS in identifying pathogens associated with PSII.
Main Methods:
- A retrospective cohort study analyzed clinical data from 122 patients with suspected surgical site infections after spinal implant surgery.
- Patients were classified into PSII (n=89) and non-PSII (n=33) groups based on NHSN criteria.
- mNGS performance was compared against traditional microbial culture, laboratory tests, and imaging studies for pathogen detection and diagnostic accuracy.
Main Results:
- mNGS demonstrated a significantly higher pathogen detection rate (79.78%) compared to traditional culture (38.20%), including detection in 42.70% of culture-negative PSII cases.
- Key pathogens identified by mNGS included Staphylococcus aureus, coagulase-negative staphylococci, Mycobacterium tuberculosis, and anaerobic bacteria.
- mNGS showed superior diagnostic performance metrics, including sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and AUC, compared to culture.
Conclusions:
- mNGS significantly enhances the detection of challenging pathogens like M. tuberculosis and anaerobes in PSII, improving upon conventional methods.
- Combining mNGS with traditional diagnostic techniques is recommended to improve accuracy, guide rational antibiotic selection, and ultimately enhance treatment outcomes for PSII.
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