Department of Pediatrics, New York Medical College, Valhalla, New York, USA,
Department of Pediatrics, New York Medical College, Valhalla, New York, USA.
Respiration. 2021;100(4):356-363. doi: 10.1159/000513250. Epub 2021 Mar 16.
Pulmonary complications often cause morbidity and mortality in pediatric allogeneic hematopoietic stem cell transplant (HSCT) recipients. While detection of infection and initiation of appropriate antimicrobial therapy improves survival, present techniques oftentimes do not detect infections in bronchoalveolar lavage (BAL) samples because of pretreatment with antimicrobial therapies and the need for a priori knowledge of likely viral pathogens, decreasing the yield of BAL.
We evaluated whether RNA-based massively parallel sequencing (MPS) would improve detection of infections in BAL fluid in pediatric allogeneic HSCT recipients.
Nine patients underwent 10 BAL (1 patient underwent 2 BAL) and had sufficient BAL fluid for inclusion in this study. Clinical microbiological testing identified infections in 7 patients, and MPS identified infections in 5 patients, although some of these detected organisms were not detected by clinical testing. Results were fully concordant in 5 patients, fully discordant in 3 patients, and partially discordant in 2 patients. Bacterial, viral, and fungal infections were detected via both techniques.
This suggests that MPS in conjunction with routine clinical testing increases the yield of detection of infectious organisms in the BAL fluid.
肺部并发症常导致儿科异基因造血干细胞移植（HSCT）受者发病率和死亡率升高。虽然检测感染并及时开始适当的抗菌治疗可以提高生存率，但目前的技术通常无法检测支气管肺泡灌洗液（BAL）样本中的感染，因为患者在接受预处理时使用了抗菌药物，并且需要预先了解可能的病毒病原体，这降低了 BAL 的检出率。
我们评估了基于 RNA 的大规模平行测序（MPS）是否可以提高儿科异基因 HSCT 受者 BAL 液中感染的检出率。
9 名患者接受了 10 次 BAL（1 名患者接受了 2 次 BAL），有足够的 BAL 液可供纳入本研究。临床微生物学检测在 7 名患者中发现了感染，MPS 在 5 名患者中发现了感染，但临床检测并未检测到部分检测到的病原体。在 5 名患者中结果完全一致，在 3 名患者中完全不一致，在 2 名患者中部分不一致。两种技术均可检测细菌、病毒和真菌感染。
这表明 MPS 联合常规临床检测可提高 BAL 液中感染性病原体的检出率。
