The application value of metagenomic next-generation sequencing in community-acquired purulent meningitis after antibiotics intervention

Abstract

Abstract Background Bacteria account for nearly one-third of the causes of community-acquired central nervous system infections, and the traditional diagnostic methods of such diseases rely on culture results, which is time-consuming, low detection rate and delayed diagnosis and treatment. Since metagenomic next-generation sequencing (mNGS) has the advantages of high timeliness and only detecting microbial trace gene fragments, it has been more widely used in recent years. Based on this, we explored whether the application of cerebrospinal fluid next-generation sequencing is advantageous in patients with community-acquired purulent meningitis, especially in people who have already used antibiotics. Methods This was a retrospective analysis of 63 patients with community-acquired purulent meningitis admitted to the neurology Department of Shanxi Bethune Hospital from March 2018 to November 2022. Data were systematically collected and sorted into CSF culture group, blood culture group and CSF mNGS group according to different detection methods, and the total detection rate of each detection method was calculated. Each group of patients was divided into two subgroups according to whether antibiotics were used before sampling, and whether there was a difference in detection rate between and within the three groups, so as to explore whether mNGS had advantages over traditional detection methods. Results Among the 63 patients, CSF culture, blood culture and CSF mNGS cases were 56, 46, 44, respectively. The total detection rates of the three methods were 17.86%, 36.96%, 81.82%, respectively, suggesting that the detection rate of mNGS was better than CSF culture and blood culture, and the detection rate of blood culture better than that of CSF culture. Further according to whether antibiotics were used before sampling, it was found that without antibiotics, the detection rates of CSF culture, blood culture and CSF mNGS were 28.57%, 56.25% and 88.89%, respectively, and the detection rate of CSF mNGS was better than that of CSF culture, but there was no statistical difference between CSF and blood culture. The detection rates of antibiotics used in the three groups were 14.29%, 26.67% and 80.00%, respectively, and the detection rate of CSF mNGS was still higher than that in CSF culture and blood culture. However, the detection rate of CSF mNGS also decreased after antibiotics were used for more than3 days. Conclusions The detection rate of CSF mNGS in patients with purulent meningitis is better than traditional methods, especially for patients who have been given antibiotics, but the detection rate will decrease with the extension of antibiotic use time.