Objective: To explore the role of metagenomic next-generation sequencing (mNGS) in the diagnosis of pathogens in primary infectious diseases of the spine (IDS) and to reveal its pathogen spectrum. Methods: This is a retrospective multi-center case series study. Clinical data of 380 patients with primary IDS who were treated at four medical centers in China from December 2019 to April 2024 were retrospectively analyzed. Among them, 82 cases were from the Department of Spine Surgery at the Affiliated Hospital of Qingdao University, 129 cases were from the Orthopedics Section Ⅱ (Bone Infection), Public Health Clinical Center Affiliated to Shandong University, 112 cases were from the Department of Spine Surgery, Fuzhou Second General Hospital, and 57 cases were from the Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. There were 238 males and 242 females, with an age of (61.4±13.1) years (range: 10 to 91 years). Specimens from the site of spinal infection were obtained for pathogen culture, pathological examination, and mNGS detection preoperatively or intraoperatively in all patients. The number, types, and positive rates of pathogens detected by the two methods were analyzed and compared using the Chi-square test. Results: Among the 380 patients, 320 had confirmed pathogenic bacteria, with the highest proportion being pyogenic bacterial infections, accounting for 76.9% (246/320). The most common pathogen was Staphylococcus aureus, accounting for 22.8% (73/320). Brucella accounted for 13.8% (44/320); Mycobacterium tuberculosis accounted for 6.3% (20/320). Fungal infections accounted for 3.4% (11/320), mainly Aspergillus and Candida. In addition, Mycoplasma was detected in 3 cases (0.9%) and Benacox body in 4 cases (1.2%). The pathogen spectrum constructed by mNGS covered 46 types of pathogens, higher than the 22 types detected by traditional methods. The positive rate of mNGS was 80.8% (308/381), significantly higher than the 27.9% (106/381) of traditional methods (χ2=182.53, P<0.01). Conclusions: mNGS improves the positive rate of pathogen diagnosis in IDS, detecting a broader spectrum of pathogens, and serves as a valuable complement to traditional diagnostic methods. Combining both methods in the diagnosis of IDS can maximize detection rates, providing robust evidence for precise anti-infective treatment.
目的： 探讨宏基因组二代测序技术（mNGS）诊断原发性脊柱感染性疾病（IDS）病原体的价值，并分析IDS的病原体谱。 方法： 本研究为回顾性、多中心病例系列研究。回顾性分析2019年12月至2024年4月于中国4个医疗中心就诊的380例原发性IDS患者的临床资料。其中青岛大学附属医院脊柱外科82例，山东大学附属公共卫生临床中心骨外二科（骨感染）129例，福州市第二总医院脊柱外科112例，上海交通大学医学院附属第六人民医院骨科57例。男性238例，女性242例，年龄（61.4±13.1）岁（范围：10~91岁）。所有患者通过病灶穿刺或术中获取脊柱感染部位标本进行病原体培养、病理学检查和mNGS检测。分析传统检测方法与mNGS检出的病原体数量、种类及阳性率，并采用χ2检验进行比较。 结果： 在380例患者中，320例明确病原体，其中化脓性细菌感染的比例占76.9%（246/320），最常见的是金黄色葡萄球菌（22.8%，73/320）；布鲁氏菌感染占13.8%（44/320）；结核分枝杆菌感染占6.3%（20/320）。真菌感染占3.4%（11/320），主要为曲霉菌和念珠菌。此外，检出支原体3例（0.9%）和贝纳柯克斯体4例（1.2%）。通过mNGS检测构建的病原体谱涵盖46种致病微生物，高于传统检测方法的22种。mNGS的阳性率为80.8%（308/381），高于传统检测方法的27.9%（106/381）（χ2=182.53，P<0.01）。 结论： mNGS提高了IDS病原体诊断的阳性率，检测出更广泛的病原体谱，是传统病原体培养检测方法的有益补充。在IDS诊断中结合使用两种方法，可提高检出率，为精准抗感染治疗提供坚实依据。.