| Research BackgroundThe incidence of spinal infection is increasing year by year.Fever and low back pain are common clinical symptoms in patients with spinal infection.Diagnosis of spinal infections may remain challenging due to the lack of specific clinical features and laboratory findings,which require different means of testing,including serology,pathogenic microbiology and imaging examination.Spinal infection patients with a variety of pathogens,its clinical manifestations,laboratory examination,imaging examination lack of specificity,clinical diagnosis is not easy,anti-infective course of treatment is long,slow,the curative effect is not easy to judge,clinical easy to misdiagnosis and mistreatment.Therefore,etiological diagnosis is very important,but traditional culture(blood culture,tissue culture)takes a long time and has low positive rate.The metagenomics next-generation sequencingm(NGS)as a new pathogenic microorganism detection means,is relative to the generation of DNA sequencing technology new sequencing method.At present,mNGS has been applied to the pathogen diagnosis of various infectious diseases,and has shown good diagnostic performance.However,there are few studies on the diagnostic value of mNGS for pathogens in patients with spinal infection,and few studies on the potential diagnostic value of tissue culture and mNGS in patients with spinal infection.ObjectiveTo investigate the efficacy of mNGS in the etiological diagnosis of patients with spinal infection,and to provide an important reference for clinicians in the timely diagnosis of patients with spinal infection.MethodsThis study is a retrospective study.40 patients with spinal infection admitted to the Department of Infection of Henan Provincial People’s Hospital from January 2020 to July 2022 were included.Retrospective analysis of the general situation of the patients,including sex,age,underlying diseases,first symptoms,postoperative radiation of malignant tumor,history of chemotherapy,history of pre-admission use of antibiotics,site of infection,potential route of infection.Inflammatory indexes at admission:including white blood cell(WBC)count,peak WBC count during hospitalization,NE count on admission,peak NE count during hospitalization,NE%on admission,peak NE%during hospitalization,CRP on admission,peak CRP during hospitalization,ESR on admission,and peak ESR during hospitalization.Results of blood culture,tissue culture,tissue mNGS,histopathology and imaging.Histopathological results were used as the diagnostic criteria,and the pathology showed neutrophils,lymphocytes,plasma cells,multinucleated giant cells,epithelioid cells,histiocytes and other acute and chronic inflammatory cell infiltration in local lesions,and lymphohematopoietic system tumors(such as lymphoma,plasma cell tumor,Langerhans cell histiocytosis)were excluded.That is,patients with histopathologically positive spinal infection were the study group(n=28 cases).Pathological results did not suggest the above inflammatory cell types,but the clinical symptoms,signs,infective indicators,pathogenic microorganism examination or empirical anti-infective efficacy evaluation,and imaging examination met the clinical diagnostic criteria of spinal infection,that is,the patients with histopathologically negative spinal infection were the control group(n=12 cases).SPSS 20.0 software was used for statistical analysis.The comparison of inflammatory indicators between the two groups was performed using the Mann-Whitney U test.The positive rate,sensitivity and specificity of both mNGS and tissue culture assays for the detection of pathogens in patients with spinal infection and the Kappa concordance test were analyzed using the paired chi-square test(McNemar test).P<0.05 was considered a statistically significant difference.ResultsOf the 40 patients with spinal infection,23(57.5%)were male and 17(42.5%)were female,with an age of(62.0± 15.7)years and a range of(13.0-83.0)years.Basic diseases:12 patients had type 2 diabetes(30.0%),including 4 patients with simple diabetes,19 patients with hypertension(47.5%),including 11 patients with simple hypertension,and 8 patients with type 2 diabetes mellitus complicated with hypertension(20.0%).The site of infection was mainly lumbar vertebrae(45.0%),followed by lumbosacral vertebrae(17.5%),thoracic vertebrae(15.0%),thoracolumbar vertebrae(12.5%),and cervicothoracic vertebrae(2.5%).Potential route of infection:8 patients had a history of acupuncture and physiotherapy before onset(20.0%),9 cases had lumbar surgery(22.5%),2 cases had abdominal infection(5%),and 6 cases had bloodstream infection before admission(15.0%).One case of rectal malignant tumor was treated with radiotherapy and chemotherapy(2.5%).25 patients had a history of antimicrobial therapy before admission(62.5%).There was no significant difference in sex ratio and age constituent ratio between the study group and the control group(P>0.05).There was no significant difference in WBC count at admission,NE count at admission,NE%at admission,CRP at admission,ESR at admission,peak WBC count during hospitalization,peak NE count during hospitalization,peak NE%count during hospitalization,CRP peak during hospitalization and ESR peak during hospitalization between 2 groups(P>0.05).Sensitivity and specificity analysis of mNGS for the diagnosis of patients with spinal infection:The sensitivity,specificity,positive predictive value and negative predictive value of mNGS for patients with spinal infection were 82.1%,33.3%,74.2%and 44.4%,respectively,while those of tissue culture for patients with spinal infection were 17.9%,100%,100%and 34.3%.The sensitivity of mNGS in the diagnosis of spinal infection was higher than that of tissue culture(82.1%vs 17.9%),and the difference was statistically significant(χ2=0.02,P<0.001).the specificity of mNGS for the diagnosis of spinal infection was not statistically significant(P>0.05).Kappa concordance test between mNGS and tissue culture for the diagnosis of spinal infection:Kappa=0.018.P>0.05,which was not statistically significant.Comparison of mNGS and tissue culture on the positive rate of pathogen detection in patients with spinal infection:among the 40 patients,mNGS was positive in 30 cases,with a positive rate of 75.0%,of which 4 cases were positive in both mNGS and tissue culture,and 26 cases were only mNGS Positive.Tissue culture was positive in 5 cases,and the positive rate was 12.5%,of which 1 case was only positive in tissue culture,and the positive rate of mNGS was higher than that in tissue culture,and the difference was statistically significant(χ2=0.08,P<0.001).Conclusion1.This study showed that the sensitivity of mNGS in detecting pathogens of spinal infection was better than that of tissue culture,and there was no significant difference in specificity.2.This study showed that the total positive rate of mNGS for pathogens of spinal infection was significantly higher than that of tissue culture,and has important diagnostic value in etiological diagnosis of patients with spinal infection. |
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