mNGS for CSI. metagenomic next-generation sequencing

Objective: Suffering from sepsis is one of the main causes of death in people with cervical spine injury (CSI). However, there is no effective measure to diagnose sepsis timely. The aim of this study is to investigate features of pathogens in sepsis and evaluate the potential clinical impact of Metagenomic next-generation sequencing (mNGS) on the prognosis of these patients. Methods: This retrospective study was conducted in the Changzheng Hospital from February 2018 to June 2019. The demographic and Clinic data were obtained from the patients and the registry database. Pathogens in the patients’ plasma were detected by the mNGS. The results of bacteria, viruses, and fungi were counted by stratum-specific analyses. The Kaplan-Meier plots were used to visualize survival curves. A Cox proportional hazards model was used to identify independent prognostic factors for survival. Results: Of these septic patients with CSI, 129 bacterial species, 8 viral species, and 51 fungal species were detected in 27 blood samples. The frequency of Tyzzerellanexilis was in the first place. The positive results indicated only 11.1% in blood culture, while 85.2% in mNGS. In correlation analysis, mNGS results were strongly correlated with that of bacteria and viruses. Positive results of blood culture were closely correlated with an increased hazard ratio (HR) (P = 0.0155), while the combined culture was correlated with a decreased HR (P = 0.0207). In survival analysis, The HR for death in the positive results of blood cultures was 7.81 (P = 0.0009). However, the survival had no difference in mNGS, mNGS_BAC, mNGS_VIR in the condition of combined and other cultures. Conclusions: Our results suggested that mNGS application may provide evidence for clinicians to use antibiotics when a CSI case is diagnosed with sepsis. Keywords: Metagenomic next-generation sequencing; Plasma; Sepsis; Cervical spine injury.