Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
Int J Infect Dis. 2022 Sep;122:921-929. doi: 10.1016/j.ijid.2022.07.060. Epub 2022 Jul 28.
This study aimed to evaluate the clinical value of metagenomic next-generation sequencing (mNGS) in patients with suspected lower respiratory tract infections.
This retrospective study reviewed patients with suspected lower respiratory tract infections at the Wuhan Union Hospital. Data including demographic, laboratory, and radiological profiles; treatment; and outcomes were recorded and analyzed.
mNGS identified pathogenic microbes in 100/140 (71.4%) patients, although 135 (96.4%) had received empiric antibiotic treatment before the mNGS tests. Single bacterial infection (35/100, 35%) was the most common type of infection in patients with positive mNGS results, followed by single fungal infection (14/100, 14%), bacterial-viral coinfection (14/100, 14%), single viral infection (12/100, 12%), bacterial-fungal coinfection (9/100, 9%), fungal-viral coinfection (9/100, 9%), and bacterial-fungal-viral coinfection (7/100, 7%). Moreover, compared with culture test, mNGS showed higher sensitivity (63/85, 74.1% vs 22/85, 25.9% P = 0.001) and lower processing time (24 hours vs 48 hours). Antibiotic treatment was adjusted or confirmed based on the mNGS results in 123 (87.9%) patients, including five (3.6%), 33 (23.6%), and 85 (60.7%) patients, in whom treatment was downgraded, upgraded, and unchanged, respectively. Almost all patients, regardless of escalation, de-escalation, or no change in treatment, showed significant improvement in clinical symptoms and inflammatory indicators. In addition, 17 (12.1%) patients were referred to Wuhan Pulmonary Hospital for further treatment because of confirmed or suspected tuberculosis.
mNGS could be a promising technique for microbiological diagnosis and antibiotic management, potentially improving outcomes for patients.
本研究旨在评估宏基因组下一代测序（mNGS）在疑似下呼吸道感染患者中的临床价值。
本回顾性研究回顾了武汉协和医院疑似下呼吸道感染患者的资料。记录并分析了患者的人口统计学、实验室和影像学特征；治疗方法和结局。
尽管 135 例（96.4%）患者在进行 mNGS 检测前已接受经验性抗生素治疗，但 mNGS 仍在 140 例患者中（71.4%）鉴定出了病原体微生物。阳性 mNGS 结果患者中最常见的感染类型为单一细菌感染（35/100，35%），其次为单一真菌感染（14/100，14%）、细菌-病毒混合感染（14/100，14%）、单一病毒感染（12/100，12%）、细菌-真菌混合感染（9/100，9%）、真菌-病毒混合感染（9/100，9%）和细菌-真菌-病毒混合感染（7/100，7%）。此外，与培养试验相比，mNGS 的敏感性更高（63/85，74.1% vs 22/85，25.9%，P=0.001），处理时间更短（24 小时 vs 48 小时）。根据 mNGS 结果，123 例（87.9%）患者调整或确认了抗生素治疗，其中 5 例（3.6%）、33 例（23.6%）和 85 例（60.7%）患者的治疗分别降级、升级和不变。几乎所有患者，无论治疗是否升级、降级或不变，临床症状和炎症指标均显著改善。此外，17 例（12.1%）患者因确诊或疑似结核病而转诊至武汉肺科医院进一步治疗。
mNGS 可能是一种很有前途的微生物诊断和抗生素管理技术，有望改善患者的预后。
