比较脓毒症患者下一代测序与标准血培养诊断方法的临床性能。

Comparative of clinical performance between next-generation sequencing and standard blood culture diagnostic method in patients suffering from sepsis.

机构信息

Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

出版信息

J Microbiol Immunol Infect. 2022 Oct;55(5):845-852. doi: 10.1016/j.jmii.2022.07.011. Epub 2022 Aug 7.

DOI:10.1016/j.jmii.2022.07.011

PMID:35995673

Abstract

BACKGROUND

Next-generation sequencing (NGS) is a massively unbiased sequencing technology. The objective of this study was to evaluate the performance of NGS-based approach in the detection of microorganisms from septic patients and compare with results of blood culture (BC).

METHODS

The observational and non-interventional study was conducted from April 2019 to August 2019.

RESULTS

A total of 96 sets of BC and 48 NGS results obtained from 48 septic patients were analyzed in this study. Thirty-two microorganisms (27 bacteria, 3 fungi and 2 viral) were detected by NGS in 23 (47.9%) patients; and 18 bacteria in 18 (37.5%) patients by BC. Exclusion of skin commensals, the positivity of NGS and BC was 62.5% and 14.5%, respectively (P < 0.001). Microorganisms identified by NGS demonstrated positive agreement with BC in 12 (25%) patients, including concordant results in 11 (22.9%) cases, and discrepancy results in 1 (2%). Of 11 patients with concordant results, 4 had additional microorganisms detected by NGS. NGS-positive but BC-negative was found in 9 (18.7%) patients. Using NGS, difficult-to-culture micro-organisms such as Pneumocystic jirovecii was identified in 2 patients, and Leptospira interrogans in one. Six (12.5%) patients with BC-positive but NGS-negative, whereas skin commensals were isolated in 4 (66.6%) cases. The number of patients that were positive by BC only increase from 29% to 47.9% when combining NGS and BC analyses (P = 0.033).

CONCLUSIONS

Our study support the advantage of NGS for the diagnosis of infecting microorganisms in sepsis, especially for microorganisms that are currently difficult or impossible to culture.

摘要

背景

下一代测序（NGS）是一种大规模无偏测序技术。本研究的目的是评估基于 NGS 的方法在检测脓毒症患者微生物中的性能，并与血液培养（BC）的结果进行比较。

方法

这项观察性和非干预性研究于 2019 年 4 月至 2019 年 8 月进行。

结果

本研究共分析了 48 例脓毒症患者的 96 套 BC 和 48 份 NGS 结果。32 种微生物（27 种细菌、3 种真菌和 2 种病毒）在 23 例（47.9%）患者中通过 NGS 检测到；18 种细菌在 18 例（37.5%）患者中通过 BC 检测到。排除皮肤共生菌后，NGS 和 BC 的阳性率分别为 62.5%和 14.5%（P<0.001）。NGS 鉴定的微生物与 BC 在 12 例（25%）患者中具有阳性一致性，包括 11 例（22.9%）的一致结果和 1 例（2%）的差异结果。在 11 例具有一致结果的患者中，有 4 例患者通过 NGS 检测到了额外的微生物。9 例（18.7%）患者 NGS 阳性但 BC 阴性。使用 NGS，在 2 例患者中鉴定出了难以培养的微生物，如卡氏肺孢子虫，在 1 例患者中鉴定出了钩端螺旋体。6 例（12.5%）BC 阳性但 NGS 阴性的患者中，有 4 例（66.6%）分离出了皮肤共生菌。当将 NGS 和 BC 分析结合起来时，BC 阳性的患者比例从 29%增加到 47.9%（P=0.033）。