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病毒感染和微生物多样性对脓毒症患者的影响:一项基于宏基因组新一代测序的回顾性研究。

Effects of viral infection and microbial diversity on patients with sepsis: A retrospective study based on metagenomic next-generation sequencing.

作者信息

Duan Li-Wei, Qu Jin-Long, Wan Jian, Xu Yong-Hua, Shan Yi, Wu Li-Xue, Zheng Jin-Hao, Jiang Wei-Wei, Chen Qi-Tong, Zhu Yan, Zhou Jian, Yu Wen-Bo, Pei Lei, Song Xi, Li Wen-Fang, Lin Zhao-Fen

机构信息

Department of Emergency and Critical Care Medicine, Changzheng Hospital, the Second Military Medical University, Shanghai 200003, China.

Department of Emergency and Critical Care Medicine, Pudong New Area People's Hospital, Shanghai 201299, China.

出版信息

World J Emerg Med. 2021;12(1):29-35. doi: 10.5847/wjem.j.1920-8642.2021.01.005.

Abstract

BACKGROUND

The study aims to investigate the performance of a metagenomic next-generation sequencing (NGS)-based diagnostic technique for the identification of potential bacterial and viral infections and effects of concomitant viral infection on the survival rate of intensive care unit (ICU) sepsis patients.

METHODS

A total of 74 ICU patients with sepsis who were admitted to our institution from February 1, 2018 to June 30, 2019 were enrolled. Separate blood samples were collected from patients for blood cultures and metagenomic NGS when the patients' body temperature was higher than 38 °C. Patients' demographic data, including gender, age, ICU duration, ICU scores, and laboratory results, were recorded. The correlations between pathogen types and sepsis severity and survival rate were evaluated.

RESULTS

NGS produced higher positive results (105 of 118; 88.98%) than blood cultures (18 of 118; 15.25%) over the whole study period. Concomitant viral infection correlated closely with sepsis severity and had the negative effect on the survival of patients with sepsis. However, correlation analysis indicated that the bacterial variety did not correlate with the severity of sepsis.

CONCLUSIONS

Concurrent viral load correlates closely with the severity of sepsis and the survival rate of the ICU sepsis patients. This suggests that prophylactic administration of antiviral drugs combined with antibiotics may be beneficial to ICU sepsis patients.

摘要

背景

本研究旨在探讨基于宏基因组下一代测序(NGS)的诊断技术在识别潜在细菌和病毒感染方面的性能,以及合并病毒感染对重症监护病房(ICU)脓毒症患者生存率的影响。

方法

纳入2018年2月1日至2019年6月30日期间入住我院的74例ICU脓毒症患者。当患者体温高于38℃时,分别采集患者血液样本进行血培养和宏基因组NGS检测。记录患者的人口统计学数据,包括性别、年龄、ICU住院时间、ICU评分和实验室检查结果。评估病原体类型与脓毒症严重程度及生存率之间的相关性。

结果

在整个研究期间,NGS的阳性结果(118例中的105例;88.98%)高于血培养(118例中的18例;15.25%)。合并病毒感染与脓毒症严重程度密切相关,且对脓毒症患者的生存有负面影响。然而,相关性分析表明细菌种类与脓毒症严重程度无关。

结论

同时存在的病毒载量与脓毒症严重程度及ICU脓毒症患者的生存率密切相关。这表明抗病毒药物与抗生素联合预防性给药可能对ICU脓毒症患者有益。

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