Next-Generation Sequencing Quickly Identifies Mycobacterium smegmatis in Spine Implant Infection A Case Report

We present the case of a 62-year-old woman who underwent revision surgery because of screw displacement after C1 to C3 laminectomy and occiput to C5 posterior fusion. Culture of tissue obtained intraoperatively grew nontuberculous mycobacteria (NTM) in 5 days; however, a specific species was not identified using culture until 5 weeks after sample collection. In contrast, next-generation sequencing analysis performed on samples obtained during a subsequent irrigation and debridement confirmed the presence of Mycobacterium smegmatis within 1 week. Although traditional culture identified a rapidly growing NTM in this case of spine implant infection, the species was not identified in a timely manner. Accurate and rapid species-level pathogen identification is imperative in the targeted treatment of NTM infections including spine implant infection. The use of molecular testing, such as next-generation sequencing, is helpful in identifying infecting organisms and guiding antimicrobial treatment.