The application value of metagenomic next-generation sequencing technology in the diagnosis and treatment of neonatal infectious meningitis – a single center retrospective case-control study

ABSTRACT

Objective

This retrospective study was conducted to investigate the application value of metagenomics next generation sequencing (mNGS) technology in the diagnosis and treatment of neonatal infectious meningitis.

Methods

From 1 January 2020 to 31 December 2022, 73 newborns suspected of infectious meningitis were hospitalized. After screening by inclusion and exclusion criteria, 69 newborns were subsequently included in the study, containing 27 cases with positive mNGS result and 42 cases with negative mNGS result. Furthermore, according to the diagnosis of meningitis, mNGS positive group and mNGS negative group were further divided into infectious meningitis with mNGS (+) group (n = 27) and infectious meningitis with mNGS (-) group (n = 26), respectively.

Results

(1) Compared with cerebrospinal fluid (CSF) culture, mNGS has better diagnostic value [positive predictive value (PPV) = 100.00% (27/27), negative predictive value (NPV) = 38.10% (16/42), agreement rate = 62.32% (43/69), area under the curve (AUC) = 0.750, 95% confidence interval (CI): 0.636–0.864]. (2) There were significant differences in the onset age, age at first CSF test, CSF leukocyte count, CSF glucose, positive rate of CSF culture, blood leukocyte count, procalcitonin (PCT), C-reaction protein (CRP), age at first mNGS test and adjusting anti-infective medication in the comparison between infectious meningitis with mNGS (+) group and infectious meningitis with mNGS (-) group (p < 0.05). (3) mNGS could help improve the cure rate [crude odds ratio (OR) = 3.393, 95%CI: 1.072–10.737; adjusted OR = 15.580, 95%CI: 2.114–114.798].

Conclusion

Compared with classic meningitis detection methods, mNGS has better PPV, NPV, agreement rate, and AUC. mNGS could help improve the cure rate.

KEYWORDS:

• Metagenomic next-generation sequencing technology
• central nervous system infection
• neonate
• diagnosis
• prognosis

Acknowledgments

The authors would like to thank the support of laboratory department of Children’s Hospital of Nanjing Medical University.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The dataset used during this study is available from the corresponding author upon reasonable request.

Authors contributions

Yang Yang and Yun-su Zou wrote the manuscript. Rui Cheng revised the manuscript. Zhao-lan Cao and Yan Guo collected the clinical data. Bei-bei Wang and Jia-li Wang analyzed the data. Xiao-guang Zhou and Yang Yang designed this study.

Consent for publication

The authors have read this manuscript and agreed to submit this manuscript for publication.

Ethical approval

This study was approved by the ethics committee of the Children’s Hospital of Nanjing Medical University (Number: NJCH202004037–1). The study was exempt from informed consent by the institutional review board committee (the Children’s Hospital of Nanjing Medical University) due to its retrospective nature. All data were fully anonymized before further statistical analysis. All the procedures were followed per the Declaration of Helsinki.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.