Department of Extracorporeal Life Support Center, Department of Cardiac Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Cardiology, Cardiovascular Center, Henan Key Laboratory of Hereditary Cardiovascular Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Cell Infect Microbiol. 2022 Aug 12;12:877205. doi: 10.3389/fcimb.2022.877205. eCollection 2022.
There are few studies of metagenomic next-generation sequencing (mNGS) in immunocompromised patients assisted by veno-venous extracorporeal membrane oxygenation (vv-ECMO). The present study is aimed to investigate the pathogen-detected effect and clinical therapy value of mNGS technologies in immunocompromised patients assisted by vv-ECMO.
Our study retrospectively enrolled 46 immunocompromised patients supported by vv-ECMO from Jan 2017 to June 2021 at the First Affiliated Hospital of Zhengzhou University, respectively. Patients were divided into the deterioration group (Group D) (n = 31) and improvement group (Group I) (n = 15) according to their outcomes. Baseline characteristics and etiological data of patients during hospitalization of 2 groups were compared. The pathogens detected by mNGS and antibiotic regimens guided by mNGS in immunocompromised patients assisted by vv-ECMO were analyzed.
Compared with Group I, the deterioration patients showed a higher percentage of chronic obstructive pulmonary disease (COPD) (32.3% vs. 6.7%, < 0.01) and were significantly older (47.77 ± 16.72 years vs. 32 ± 15.05 years, < 0.01). Within 48 h of being ECMO assisted, the consistency of the samples detected by traditional culture and mNGS at the same time was good (traditional culture vs. mNGS detection, the positive rate of bronchoalveolar lavage fluid (BALF) culture: 26.1% vs. 30.4%; the positive rate of blood sample culture: 12.2% vs. 12.2%, > 0.05). However, mNGS detected far more pathogen species and strains than conventional culture (30 strains vs. 78 strains, < 0.01); the most popular pathogen was . Parts of patients had their antibiotic treatment adjustments, and the improvement patients showed less usage of broad-spectrum antibiotics.
mNGS may play a relatively important role in detecting mixed pathogens and personalized antibiotic treatment in immunocompromised patients assisted by vv-ECMO.
体外膜肺氧合（ECMO）支持下免疫功能低下患者的宏基因组下一代测序（mNGS）研究较少。本研究旨在探讨 mNGS 技术在 ECMO 支持下免疫功能低下患者中的病原体检测效果及临床治疗价值。
回顾性分析 2017 年 1 月至 2021 年 6 月在郑州大学第一附属医院接受 ECMO 支持的 46 例免疫功能低下患者的临床资料。根据患者的预后，将患者分为恶化组（n = 31）和改善组（n = 15）。比较两组患者住院期间的基线特征和病因数据。分析 ECMO 支持下免疫功能低下患者 mNGS 检测的病原体和 mNGS 指导下的抗生素治疗方案。
与改善组相比，恶化组患者慢性阻塞性肺疾病（COPD）的比例更高（32.3%比 6.7%， < 0.01），年龄明显更大（47.77 ± 16.72 岁比 32 ± 15.05 岁， < 0.01）。在 ECMO 辅助的 48 小时内，同时进行的传统培养和 mNGS 检测的样本一致性较好（BALF 培养的传统培养与 mNGS 检测阳性率：26.1%比 30.4%；血样培养阳性率：12.2%比 12.2%， > 0.05）。然而，mNGS 检测到的病原体种类和菌株远远多于传统培养（30 株比 78 株， < 0.01）；最常见的病原体是. 部分患者进行了抗生素治疗调整，改善组患者广谱抗生素的使用量较少。
mNGS 可能在 ECMO 支持下免疫功能低下患者混合病原体的检测和个体化抗生素治疗中发挥相对重要的作用。
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