ADVANCING POSTOPERATIVE CARE: METAGENOMIC SEQUENCING FOR INFECTION DETECTION AFTER VENTRICULOPERITONEAL SHUNT SURGERY AND ITS IMPACT ON ATHLETIC REHABILITATION

Abstract

Background: Ventriculoperitoneal shunt (VPS) surgery is a crucial intervention for obstructive hydrocephalus, yet postoperative infections can lead to shunt failure and complicate recovery, impacting patients, including athletes who may require rapid return to activity. Traditional pathogen detection via cerebrospinal fluid (CSF) culture has limitations, particularly under low pathogen loads, often failing to guide timely medical responses. Methods: This study reviews the treatment of 10 patients experiencing intracranial infections post-VPS surgery from 2019 to 2022, employing both conventional clinical culture and cutting-edge metagenomic next-generation sequencing (mNGS). The integration of antibiotic susceptibility testing and serologic assessment helped tailor and evaluate treatment strategies, while mNGS provided dynamic monitoring of pathogen load and treatment effectiveness. Results: Infections primarily caused by Staphylococcus aureus were confirmed via both mNGS and culture, with mNGS showing superior sensitivity. Initial treatments with vancomycin and levofloxacin were optimized based on susceptibility tests. mNGS enabled precise tracking of pathogen load reductions, which were more detailed and consistent compared to traditional culture results. While cultures failed in subsequent biopsies, mNGS continued to confirm decreasing pathogen presence, substantiating the ongoing treatment efficacy. Conclusion: The application of mNGS offers a more sensitive and rapid method for detecting pathogens and monitoring treatment responses in VPS-related infections. This method not only provides a more reliable basis for medical decisions but also supports a faster and safer return to function, which is particularly vital for athletes undergoing rehabilitation. The findings advocate for the integration of mNGS into standard postoperative care to enhance recovery outcomes and guide surgical interventions more effectively.