Clinical application of targeted next-generation sequencing in detecting organ/space surgical site infection in patients following biliary-pancreatic surgery.

BACKGROUND

Organ/space surgical site infection (SSI) is a common and severe complication following biliary-pancreatic surgery. Rapid and accurate diagnosis is crucial for managing organ/space SSI. The clinical application of targeted next-generation sequencing (tNGS) in biliary-pancreatic surgery remains limited.

METHODS

This retrospective study enrolled 73 consecutive patients who underwent biliary-pancreatic surgery between January 2025 and June 2025, among whom 27 patients were clinically diagnosed with organ/space SSI. Abdominal drainage specimens were collected and analyzed using tNGS and conventional microbiological tests (CMTs). The diagnostic performance, pathogen spectrum, and turnaround time of the two methods were evaluated.

RESULTS

The overall pathogen detection rate was higher for tNGS than for CMTs (52.1% vs. 39.7%). tNGS showed higher sensitivity (92.6% vs. 66.7%) and negative predictive value (94.3% vs. 79.5%) than CMTs in organ/space SSI, with a shorter turnaround time (28.1 h vs. 109.1 h). tNGS revealed a broader pathogenic spectrum than CMTs (23 vs. 12 species). Moreover, advanced age (OR = 1.052, 95%CI = 1.005-1.100 p = 0.029) and preoperative biliary drainage (PBD) (OR = 9.411, 95%CI = 1.060-83.524, p = 0.044) were associated with tNGS positivity in exploratory multivariate analysis.

CONCLUSION

tNGS may provide rapid adjunctive microbiological information for early etiological assessment of organ/space SSI after biliary-pancreatic surgery, but it should complement rather than replace CMTs and clinical assessment.