Zhan Yangqing, Xu Teng, He Fusheng, Guan Wei-Jie, Li Zhengtu, Li Shaoqiang, Xie Mingzhou, Li Xiaolei, Chen Rongchang, Cheng Linling, Zhong Nanshan, Ye Feng
State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, Guangzhou, China.
Vision Medicals Co., Ltd., Guangzhou, China.
Front Microbiol. 2021 Sep 16;12:751073. doi: 10.3389/fmicb.2021.751073. eCollection 2021.
Clinical value of metagenomic next-generation sequencing (mNGS) in pneumonia management is still controversial. A prospective study was conducted to evaluate the clinical impact of PneumoSeq in 57 immunocompetent (ICO) and 75 immunocompromised (ICH) pneumonia patients. The value of PneumoSeq for both etiological and clinical impact investigation in pneumonia was assessed. Among the 276 potential pathogens detected with PneumoSeq in our cohort, 251 (90.9%) were cross-validated. Clinical diagnoses of the causative pathogens were obtained for 97 patients, 90.7% of which were supported by PneumoSeq. Compared to conventional testing, PneumoSeq suggested potentially missed diagnoses in 16.7% of cases (22/132), involving 48 additional pathogenic microorganisms. In 58 (43.9%) cases, PneumoSeq data led to antimicrobial treatment de-escalation ( = 12 in ICO, = 18 in ICH) and targeted treatment initiation ( = 7 in ICO, = 21 in ICH). The PneumoSeq assay benefited the diagnosis and clinical management of both ICH and ICO pneumonia patients in real-world settings.
宏基因组下一代测序（mNGS）在肺炎管理中的临床价值仍存在争议。开展了一项前瞻性研究，以评估PneumoSeq对57例免疫功能正常（ICO）和75例免疫功能低下（ICH）肺炎患者的临床影响。评估了PneumoSeq在肺炎病因学和临床影响调查方面的价值。在我们队列中用PneumoSeq检测到的276种潜在病原体中，251种（90.9%）得到了交叉验证。97例患者获得了致病病原体的临床诊断，其中90.7%得到了PneumoSeq的支持。与传统检测相比，PneumoSeq提示在16.7%的病例（22/132）中可能存在漏诊，涉及另外48种致病微生物。在58例（43.9%）病例中，PneumoSeq数据导致抗菌治疗降级（ICO组12例，ICH组18例）和启动靶向治疗（ICO组7例，ICH组21例）。在实际临床环境中，PneumoSeq检测对ICH和ICO肺炎患者的诊断及临床管理均有益处。
