Metagenomic Next-Generation Sequencing for Brain Abscess: Improved Pathogen Detection, Targeted Antimicrobial...

Area of Science:

• Neuroscience
• Infectious Diseases
• Genomics

Background:

• Brain abscess diagnosis relies on accurate pathogen identification.
• Conventional culture methods are often insufficient for complex infections like anaerobic or polymicrobial brain abscesses.

Purpose of the Study:

• To compare the diagnostic and clinical utility of metagenomic next-generation sequencing (mNGS) against conventional culture for brain abscesses.

Main Methods:

• Retrospective analysis of 115 patients with brain abscesses.
• Comparison of mNGS and conventional culture for pathogen detection.
• Evaluation of diagnostic performance, pathogen profiles, antimicrobial regimen adjustments, and clinical outcomes.

Main Results:

• mNGS demonstrated significantly higher pathogen detection rates (86.1%) than culture (44.4%).
• mNGS excelled in identifying mixed infections (53.2%), anaerobic bacteria, and oral-derived pathogens.
• Antimicrobial regimens were adjusted in 54.2% of patients based on mNGS results, often involving de-escalation.
• mNGS use was associated with a lower surgical intervention rate (47.2% vs. 65.1%).

Conclusions:

• mNGS is superior to conventional culture for diagnosing brain abscesses, especially for mixed and anaerobic infections.
• mNGS can inform targeted antimicrobial therapy and aid in identifying infection sources, potentially reducing surgical interventions.
• Integration of mNGS into diagnostic workflows for brain abscesses is supported by these findings.