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Background <p>Cat bite infections are common emergency settings and are characterized by small, deep puncture wounds that readily form an anaerobic microenvironment, leading to a high incidence of anaerobic bacterial infections. Conventional aerobic bacterial culture has extremely low detection efficiency for such infections and is prone to false-negative results and delayed treatment. As a designated regional rabies vaccination and treatment center, our hospital manages refractory and severe animal bite cases referred from primary medical institutions, with an annual volume of approximately 3000 animal bite consultations.</p> Methods <p>Clinical data were retrospectively collected for 17 patients with cat bite infections (13 mild, 4 severe) and negative traditional aerobic bacterial cultures admitted to the Emergency Department of our hospital from May 2025 to January 2026. All patients were treated with emergency debridement and empirical antibiotic therapy. For the 4 severe patients with no improvement after conventional treatment, metagenomic next-generation sequencing (mNGS) was recommended for etiological detection, with only 1 patient consenting to external testing at Beijing You’an Hospital due to economic constraints.</p> Results <p>All 17 patients had deep puncture wounds (depth &gt; 0.5&#xa0;cm), and the aerobic bacterial culture results were all negative after 72&#xa0;h of incubation. In the single severe patient who underwent mNGS testing within 24&#xa0;h of sample collection, multiple anaerobic or facultative anaerobic pathogens were identified (no viral, fungal or parasitic pathogens detected), with the specific species and their relative abundances shown in Table&#xa0;1. The dominant pathogen was <i>Bacteroides pyogenes</i> (67.5%), followed by other oral anaerobes, including <i>Fusobacterium russii</i> and <i>Porphyromonas gulae</i>; the classic cat bite pathogen <i>Pasteurella multocida</i> (1.5%) was also detected in this mixed infection. The relative abundance distribution of all identified pathogens is presented in Figure&#xa0;1, and the genome coverage plots for the key pathogenic bacteria are shown in Figure&#xa0;2. The 4 severe patients all achieved effective infection control after adjustment based on antibiotic regimens with reference to the mNGS results. The average treatment cycle of 4 severe patients was 14.5 ± 2.3 days, and that of 13 mild patients was 18.7 ± 3.1 days; no statistical analysis was performed due to the small sample size.</p> Conclusion <p>In this small single-center retrospective study, aerobic culture was negative in all 17 cat bite infection cases. In the single tested severe patient, mNGS identified multiple anaerobic and facultative anaerobic pathogens and facilitated targeted antibiotic adjustment, suggesting that mNGS may serve as a potential supplementary diagnostic tool for severe culture-negative cat bite infections in emergency settings. Given the limited sample size and the fact that only one mNGS test was performed, no broad conclusions can be drawn regarding the generalizability of mNGS. Regional rabies vaccination and treatment centers should establish standardized debridement procedures, strengthen physician‒patient risk communication, and improve the referral system to reduce the risk of severe complications and medical disputes.</p> Clinical trial number <p>Not applicable.</p>

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Metagenomic next-generation sequencing (mNGS) for severe cat bite infections with negative aerobic culture: a single-center retrospective study in a rabies vaccination center

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  • 发表日期：

    2026年4月6日

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  • Adilijiang Maimaitiming

摘要

Background

Cat bite infections are common emergency settings and are characterized by small, deep puncture wounds that readily form an anaerobic microenvironment, leading to a high incidence of anaerobic bacterial infections. Conventional aerobic bacterial culture has extremely low detection efficiency for such infections and is prone to false-negative results and delayed treatment. As a designated regional rabies vaccination and treatment center, our hospital manages refractory and severe animal bite cases referred from primary medical institutions, with an annual volume of approximately 3000 animal bite consultations.

Methods

Clinical data were retrospectively collected for 17 patients with cat bite infections (13 mild, 4 severe) and negative traditional aerobic bacterial cultures admitted to the Emergency Department of our hospital from May 2025 to January 2026. All patients were treated with emergency debridement and empirical antibiotic therapy. For the 4 severe patients with no improvement after conventional treatment, metagenomic next-generation sequencing (mNGS) was recommended for etiological detection, with only 1 patient consenting to external testing at Beijing You’an Hospital due to economic constraints.

Results

All 17 patients had deep puncture wounds (depth > 0.5 cm), and the aerobic bacterial culture results were all negative after 72 h of incubation. In the single severe patient who underwent mNGS testing within 24 h of sample collection, multiple anaerobic or facultative anaerobic pathogens were identified (no viral, fungal or parasitic pathogens detected), with the specific species and their relative abundances shown in Table 1. The dominant pathogen was Bacteroides pyogenes (67.5%), followed by other oral anaerobes, including Fusobacterium russii and Porphyromonas gulae; the classic cat bite pathogen Pasteurella multocida (1.5%) was also detected in this mixed infection. The relative abundance distribution of all identified pathogens is presented in Figure 1, and the genome coverage plots for the key pathogenic bacteria are shown in Figure 2. The 4 severe patients all achieved effective infection control after adjustment based on antibiotic regimens with reference to the mNGS results. The average treatment cycle of 4 severe patients was 14.5 ± 2.3 days, and that of 13 mild patients was 18.7 ± 3.1 days; no statistical analysis was performed due to the small sample size.

Conclusion

In this small single-center retrospective study, aerobic culture was negative in all 17 cat bite infection cases. In the single tested severe patient, mNGS identified multiple anaerobic and facultative anaerobic pathogens and facilitated targeted antibiotic adjustment, suggesting that mNGS may serve as a potential supplementary diagnostic tool for severe culture-negative cat bite infections in emergency settings. Given the limited sample size and the fact that only one mNGS test was performed, no broad conclusions can be drawn regarding the generalizability of mNGS. Regional rabies vaccination and treatment centers should establish standardized debridement procedures, strengthen physician‒patient risk communication, and improve the referral system to reduce the risk of severe complications and medical disputes.

Clinical trial number

Not applicable.