Wang Sen, Ai Jingwen, Cui Peng, Zhu Yimin, Wu Honglong, Zhang Wenhong
Department of infectious disease, Huashan Hospital of Fudan University, Shanghai 200040, China.
Binhai Genomics Institute, Tianjin Translational Genomics Center, BGI-Tianjin, Tianjin 300308, China.
Ann Transl Med. 2020 Mar;8(5):227. doi: 10.21037/atm.2020.01.30.
Next-generation sequencing (NGS) is a comprehensive approach for sequence-based identification of pathogens. However, reports on the use of NGS in patients with immunosuppression are scarce, especially in subjects with negative microbiological results.
In this study, NGS was performed on samples obtained from 108 anonymized patients with suspected infection undergoing immunosuppressive corticosteroid therapy. A panel of conventional microbiological tests (CMT) was performed in parallel with NGS.
Of these 108 subjects, 36 were diagnosed with infections by clinical and microbiological criteria (Group I), 41 were exclusively diagnosed clinically (Group II), and 31 exhibited no evidence of infection (Group III). In Group I, NGS was concordant with CMT results from 29 patients (80.6%). A total of 4 samples had positive NGS results in Group III. NGS showed a sensitivity of 80.6% (95% CI, 64.7% to 90.6%) and specificity of 87.1% (95% CI, 70.5% to 95.5%). NGS also played an important role in optimizing antibiotic regimens in patients with negative results for CMT (Group II). The treatment success rate (TSR) of patients using NGS-guided antibiotic regimens (81.8%, 18/22) was significantly higher than that of patients using empirical antibiotics (52.6%, 10/19) (P<0.0001). NGS results were not affected by the degree of immunosuppression.
NGS of clinical samples from immunosuppressed patients demonstrated promising diagnostic potential in identifying clinically relevant pathogens. Consequently NGS stands to become a standard tool for infection detection and control, providing valuable information to optimize antibiotic therapy in immunosuppressed patients.
下一代测序（NGS）是一种基于序列的病原体鉴定综合方法。然而，关于在免疫抑制患者中使用NGS的报道很少，尤其是微生物学结果为阴性的患者。
在本研究中，对108例接受免疫抑制性皮质类固醇治疗且疑似感染的匿名患者的样本进行了NGS检测。同时进行了一组传统微生物学检测（CMT）。
在这108例患者中，36例根据临床和微生物学标准诊断为感染（第一组），41例仅根据临床诊断（第二组），31例无感染证据（第三组）。在第一组中，NGS与29例患者（80.6%）的CMT结果一致。第三组共有4个样本NGS结果为阳性。NGS的敏感性为80.6%（95%CI，64.7%至90.6%），特异性为87.1%（95%CI，70.5%至95.5%）。NGS在优化CMT结果为阴性的患者（第二组）的抗生素治疗方案方面也发挥了重要作用。使用NGS指导的抗生素治疗方案的患者的治疗成功率（TSR）（81.8%，18/22）显著高于使用经验性抗生素的患者（52.6%，10/19）（P<0.0001）。NGS结果不受免疫抑制程度的影响。
对免疫抑制患者的临床样本进行NGS检测在鉴定临床相关病原体方面显示出有前景的诊断潜力。因此，NGS有望成为感染检测和控制的标准工具，为优化免疫抑制患者的抗生素治疗提供有价值的信息。
