Emerg Infect Dis. 2020 Nov;26(11):2543-2548. doi: 10.3201/eid2611.200004.
Neonatal sepsis (NS) kills 750,000 infants every year. Effectively treating NS requires timely diagnosis and antimicrobial therapy matched to the causative pathogens, but most blood cultures for suspected NS do not recover a causative pathogen. We refer to these suspected but unidentified pathogens as microbial dark matter. Given these low culture recovery rates, many non-culture-based technologies are being explored to diagnose NS, including PCR, 16S amplicon sequencing, and whole metagenomic sequencing. However, few of these newer technologies are scalable or sustainable globally. To reduce worldwide deaths from NS, one possibility may be performing population-wide pathogen discovery. Because pathogen transmission patterns can vary across space and time, computational models can be built to predict the pathogens responsible for NS by region and season. This approach could help to optimally treat patients, decreasing deaths from NS and increasing antimicrobial stewardship until effective diagnostics that are scalable become available globally.
新生儿败血症(NS)每年导致 75 万名婴儿死亡。有效治疗 NS 需要及时诊断和针对病原体的抗菌治疗,但大多数疑似 NS 的血培养都无法恢复病原体。我们将这些疑似但无法识别的病原体称为微生物暗物质。鉴于这些低培养回收率,许多非培养技术正在被探索用于诊断 NS,包括 PCR、16S 扩增子测序和全宏基因组测序。然而,这些新技术中很少有具有全球可扩展性或可持续性。为了减少全球因 NS 而导致的死亡,一种可能是进行全人群病原体发现。由于病原体传播模式会随时间和空间而变化,因此可以构建计算模型来预测特定地区和季节导致 NS 的病原体。这种方法可以帮助优化治疗患者,降低 NS 死亡率并增加抗菌药物管理,直到在全球范围内获得具有可扩展性的有效诊断方法。