Clinical Application Value of Metagenomic Next-Generation Sequencing at Perioperative Period in Patients with Central Nervous System Infections in Neurosurgical Intensive Care Unit.

Abstract

This study aims to evaluate the clinical utility of metagenomic next-generation sequencing (mNGS) for diagnosing central nervous system infections (CNSIs) during the perioperative period in neurosurgical intensive care unit (ICU) patients. In this prospective study, we included patients suspected of CNSIs during the perioperative period who were admitted to the neurosurgical ICU at Henan Provincial People's Hospital. Clinical samples were tested using both mNGS and conventional pathogen culture methods. Based on comprehensive clinical diagnoses, patients were categorized into the CNSIs and non-CNSIs groups. The diagnostic performance of mNGS was compared with traditional methods, including time to pathogen detection and evaluation of optimal testing conditions. Additionally, the study assessed whether antibiotic resistance genes detected by mNGS could predict drug resistance phenotypes. Between January 2022 and December 2023, 116 patients were enrolled, including 48 in the CNSIs group and 30 in the non-CNSIs group. mNGS identified a greater variety and quantity of pathogens compared to conventional methods. First, mNGS results were consistent with traditional culture in 5 cases. mNGS exhibited superior sensitivity (85.42% vs. 10.42%) and a higher negative predictive value (80.00% vs. 40.10%) compared to traditional cultures. Second, only 8.33% of CNSIs patients showed identical pathogens in both cerebrospinal fluid and blood samples. Third, 28.6% of cerebrospinal fluid samples with an mNGS detection interval of more than 7 days showed complete pathogen consistency, while 60% of samples with a detection interval of less than 3 days were consistent. Moreover, the antibiotic resistance genes detected by mNGS largely corresponded with the resistance phenotypes identified by antibiotic susceptibility testing. To sum up, mNGS offers excellent diagnostic accuracy and significant clinical value in CNSIs diagnosis during the perioperative period in the neurosurgical ICU, complementing traditional culture methods effectively.