From the Infectious Disease Section, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas.
Department of Pathology and Immunology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas.
Pediatr Infect Dis J. 2022 Feb 1;41(2):166-171. doi: 10.1097/INF.0000000000003395.
Plasma metagenomic next-generation sequencing (mNGS) has the potential to detect thousands of different organisms with a single test. There are limited data on the real-world impact of mNGS and even less guidance on the types of patients and clinical scenarios in which mNGS testing is beneficial.
A retrospective review of patients who had mNGS testing as part of routine clinical care at Texas Children's Hospital from June 2018-August 2019 was performed. Medical records were reviewed for pertinent data. An expert panel of infectious disease physicians adjudicated each unique organism identified by mNGS for clinical impact.
There were 169 patients with at least one mNGS test. mNGS identified a definitive, probable or possible infection in 49.7% of patients. mNGS led to no clinical impact in 139 patients (82.2%), a positive impact in 21 patients (12.4%), and a negative impact in 9 patients (5.3%). mNGS identified a plausible cause for infection more often in immunocompromised patients than in immunocompetent patients (55.8% vs. 30.0%, P = 0.006). Positive clinical impact was highest in patients with multiple indications for testing (37.5%, P = 0.006) with deep-seated infections, overall, being most often associated with a positive impact.
mNGS testing has a limited real-world clinical impact when ordered indiscriminately. Immunocompromised patients with well-defined deep-seated infections are likely to benefit most from testing. Further studies are needed to evaluate the full spectrum of clinical scenarios for which mNGS testing is impactful.
血浆宏基因组下一代测序（mNGS）有可能通过单次检测发现数千种不同的生物体。关于 mNGS 的实际影响的数据有限，关于 mNGS 检测有益的患者类型和临床情况的指导意见更少。
对 2018 年 6 月至 2019 年 8 月期间在德克萨斯儿童医院进行常规临床护理的 mNGS 检测患者进行了回顾性研究。对病历进行了回顾，以获取相关数据。传染病专家小组对 mNGS 鉴定的每种独特生物体的临床影响进行了裁决。
共有 169 例患者至少进行了一次 mNGS 检测。mNGS 在 49.7%的患者中确定了明确、可能或可能的感染。139 例患者（82.2%）mNGS 无临床影响，21 例患者（12.4%）mNGS 有积极影响，9 例患者（5.3%）mNGS 有消极影响。mNGS 在免疫功能低下患者中比免疫功能正常患者更能确定感染的合理原因（55.8%对 30.0%，P=0.006）。具有多种检测指征的患者（37.5%，P=0.006）阳性临床影响最高，总体而言，深部感染与阳性影响最相关。
mNGS 检测在随机检测时对临床的实际影响有限。明确、深部感染的免疫功能低下患者最有可能从检测中受益。需要进一步研究来评估 mNGS 检测具有影响的所有临床情况。
