Application effect of cerebrospinal fluid metagenomic next ⁃ generation sequencing in diagnosis and treatment of intracranial infection

Abstract

Objective To investigate the effect of cerebrospinal fluid (CSF) metagenomic next ⁃ generation sequencing (mNGS) in diagnosis and treatment of intracranial infection. Methods A retrospective analysis of 117 patients with intracranial infection were admitted to Shenzhen Second People's Hospital from January 2020 to December 2022. Before initiating empirical broad ⁃ spectrum antibiotic treatment, CSF samples were collected for microbial culture (conventional culture group, n = 58) and/or mNGS (mNGS group, n = 59). The results were used to adjust the antibiotic treatment plan, and the study compared the pathogen detection rates and result reporting times of the two testing methods, as well as the antibiotic intensity grading, the intensive care unit (ICU) stay, total hospital stay, and mortality rate. Results A total of 65 pathogens were detected from the CSF samples of all the patients through microbial culture and/or mNGS, with viruses being the most prevalent, accounting for 49.23% (32/65), followed by Gram⁃negative bacteria (24.62%, 16/65), Gram⁃positive bacteria (18.46%, 12/65) and fungi (7.69%, 5/65). The pathogen detection rate of CSF mNGS was higher than that of CSF microbial culture (χ2 = 22.781, P = 0.000), and the results were reported earlier (t = ⁃ 32.588, P = 0.000). Based on the results, 20 cases (33.90%) in the mNGS group adjusted antibiotic treatment plan, with 5 cases downgrading and 15 cases upgrading the intensity of antibiotic application. In the conventional culture group, 30 cases (51.72%) adjusted their antibiotic treatment plan, with 17 cases downgrading and 13 cases upgrading the intensity of antibiotic application. There was no significant difference between the 2 groups (Z = ⁃ 1.917, P = 0.055). And there was no statistically significant difference in ICU stay (Z = ⁃ 0.716, P = 0.474）, total hospital stay (Z = ⁃ 0.933, P = 0.351) and mortality rate (Fisher's exact probability: P = 0.496) between the 2 groups. Conclusions The application of mNGS can effectively improve the detection rate of intracranial infection pathogens, which may shorten the duration of antibiotic use and reduce the intensity of broad ⁃ spectrum antibiotics, so as to help clinical effective judgment and treatment decision.

DOI: 10.3969/j.issn.1672⁃6731.2024.06.004