Clinical application value of nanopore-targeted sequencing technology for primary spine infection: a mulicenter, retrospective observational study

Etiological diagnosis of primary spinal infections (PSI) is critical for ensuring precise treatment. Currently, the positive rate of microbial culture in clinical practice remains low. Recently, nanopore-targeted sequencing (NTS) has demonstrated significant advantages in the etiological diagnosis of infections at other sites. To evaluate the application value of NTS in detecting pathogens from PSI. In this multicenter retrospective study, the clinical data of 169 patients with suspected spinal infection who were admitted to Affiliated Hospital of Qingdao University, Qingdao Municipal Hospital, Jinan Public Health Medical Center from January 2019 to January 2024. According to the inclusion and exclusion criteria, all patients underwent blood and tissue samples collection after admission, samples were subjected to traditional laboratory testing protocols and NTS test. Paired χ2 test (Mcnemar test) was used to compare the positive rate of microbial culture and NTS. The kappa value was used to compare the consistency between the results of NTS and culture. Among the 169 cases, 147 were diagnosed as spinal infections, while 22 were classified as noninfectious according to the histopathological results. Microbiological evidence was found in 98 cases, while 49 cases were clinically diagnosed as spinal infections without definitive microbiological evidence. the detection rate of the pathogen is 66.7% (98/147). The positive rate of NTS was significantly higher at 80.3% (118/147) compared with microbiological culture. (38.1%, 56/147) (X^2=60.02, P < 0.001). At the genus level, the positive percentage (PPA) consistency between NTS and microbial culture was 98.2%(55/56), the negative percentage consistency (NPA) was 31.9% (29/91), and the overall percentage (OPA) consistency was 57.1% (84/147). The consistency of the results of all the two assays was low (kappa = 0.263). This study highlights the diagnostic value of NTS testing in PSI. However, microbial culture remains indispensable for clinical testing. NTS serves as a complementary approach to traditional culture testing, providing higher positive rate and shorter detection time, rendering it of immense diagnostic in the realm of spinal infection diseases. A retrospective, observational study.