The diagnostic value of blood metagenomic next-generation sequencing in patients with acute hematogenous osteomyelitis

Abstract

AimsThis study aims to evaluate the diagnostic value of blood metagenomic next-generation sequencing (mNGS) in detecting pathogens from patients clinically diagnosed as acute hematogenous osteomyelitis (AHO).MethodsThis retrospective study enrolled 66 patients with AHO. The test results of mNGS and bacterial culture on different samples, including blood and puncture fluid samples, from patients with AHO were compared to explore the diagnostic value of blood mNGS. Besides, this study also explored the efficacy of blood mNGS in decision making for antibiotic administration and analyzed the factors associated with the positive result of blood mNGS.ResultsThe most common causative pathogens were Staphylococcus and Streptococcus. The sensitivity of blood mNGS (77.3%) was higher than that of blood culture (42.4%) (P<0.001), while the turnaround time of blood mNGS (2.1 ± 0.4 d) is much less than that of blood culture (6.0 ± 2.1 d) (P<0.001). Besides, the sensitivity of blood mNGS tests (77.3%) was slightly lower than that of puncture fluid mNGS (89.4%). Furthermore, detection comparison at pathogen level unravels that blood mNGS might be suitable for diagnosing AHO caused by common pathogens, while puncture fluid mNGS could be considered as preferred examination in diagnosing AHO caused by uncommon pathogens. Finally, three independent factors associated with the true positive result of blood mNGS in patients with AHO were identified, including Gram-positive pathogens (OR=24.4, 95% CI = 1.4-421.0 for Staphylococcus; OR=14.9, 95%CI= 1.6-136.1 for other Gram-positive bacteria), body temperature at sampling time (OR=8.2, 95% CI = 0.6-107.3 for body temperature of >38.5°C; OR=17.2, 95% CI = 2.0-149.1 for patients who were chilling), and no use of antibiotics before sampling (OR=8.9, 95% CI =1.4-59.0).ConclusionThis is the first report on evaluating and emphasizing the importance of blood mNGS in diagnosing AHO. Blood sample might be an alternative sample for puncture fluid for mNGS, and its extensive application in diagnosing AHO could be expected.

Higher diagnostic value of metagenomic next-generation sequencing in acute infection than chronic infection: a multicenter retrospective study

“…Various studies have proved the clinical value of mNGS for acute infectious patients. Some studies discussed the application of mNGS in acute viral encephalitis (Cao and Zhu, 2020 ), acute respiratory distress syndrome (Zhang et al, 2021 ; Wang et al, 2022 ), acute respiratory distress syndrome (Zhang et al, 2023 ) and other acute infectious diseases, demonstrating that mNGS is a promising tool for the diagnosis of acute disease caused by multiple infectious agents. mNGS represents a valuable supplementary tool to CM in order to rapidly determine etiological factors of various infections and guide treatment decision- making for patients (Xu et al, 2023 ).…”

Metagenomic next-generation sequencing of plasma cell-free DNA improves the early diagnosis of suspected infections

“…It should be considered in conjunction with the application of traditional techniques [ 24 ], or as a first-line investigation using blood samples [ 25 ]. Additionally, several studies have focused on the diagnostic value of blood mNGS in detecting pathogens from patients with acute hematogenous osteomyelitis [ 26 ], intra-abdominal infections [ 27 ], infective endocarditis [ 28 ], febrile neutropenia [ 29 ], and transplantation [ 30 ], among others, indicating that blood mNGS can be a suitable test.…”