Application of metagenomic Next Generation Sequencing in clinically suspected central nervous system infection after neurological surgeries: A prospective study

Background Metagenomic next-generation sequencing (mNGS) is used for complex central nervous system (CNS) infection, but its application for early diagnosis of central nervous system infections (CNSI) postoperatively is unknown. This study aimed to investigate the role of mNGS in the diagnosis and management of postoperative CNSI. Methods Patients with suspected CNSI after neurological surgery between November 2021 and December 2022 in our institution were prospectively included. Cerebrospinal fluid (CSF) was collected from all patients for routine testing, bacterial culture, and mNGS. Patients were classified into two groups according to the mNGS results: the mNGS (+) and mNGS (−) groups. Accordingly, different anti-infection strategies were developed. Clinical parameters and data on antibiotic use were analyzed. Results Among 2105 surgically treated patients, 45 were included: 28 males, 17 females. Of these, 21 had a craniotomy, 18 had intraspinal surgery and 6 had transnasal neuroendoscopic surgery, ranging from 33 to 80 years (average age: 47.0 ± 14.5 years). The mNGS (+) group comprised 15 patients (30 % positive rate). One of these cases also had the pathogen detected in the CSF culture. For these cases, pathogen-targeted antibiotics were administered. The mNGS (−) group (30 patients) had 17 cases diagnosed with non-infectious meningitis and treated without antibiotics. Seven were diagnosed with mNGS (−) CNSI due to persistent meningitis symptoms and received empirical broad-spectrum antibiotics. Six mNGS (−) patients were diagnosed with pulmonary infections or sepsis. All infections were successfully treated. However, the mNGS (+) group had a shorter duration of antibiotic use. Conclusion Cerebrospinal fluid mNGS is more effective than bacterial culture for diagnosing CNS infections after craniotomy or intraspinal surgery.