宏基因组下一代测序对 ICU 与非 ICU 患者肺部感染的诊断价值。
Diagnostic Value of Metagenomic Next-Generation Sequencing for Pulmonary Infection in Intensive Care Unit and Non-Intensive Care Unit Patients.
机构信息
Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China.
Department of Emergency Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
出版信息
Front Cell Infect Microbiol. 2022 Aug 15;12:929856. doi: 10.3389/fcimb.2022.929856. eCollection 2022.
OBJECTIVE
To evaluate the diagnostic performance of metagenomic next-generation sequencing (mNGS) and culture in pathogen detection among intensive care unit (ICU) and non-ICU patients with suspected pulmonary infection.
METHODS
In this prospective study, sputum samples were collected from patients with suspected pulmonary infection for 2 consecutive days and then subjected to DNA or RNA sequencing by mNGS or culture; 62 ICU patients and 60 non-ICU patients were admitted. In the end, comparisons were made on the pathogen species identified by mNGS and culture, the overall performance of these two methods in pathogen detection, and the most common pathogens detected by mNGS between the ICU and non-ICU groups.
RESULTS
In DNA and RNA sequencing, the positive rate of pathogen detection reached 96.69% (117/121) and 96.43% (108/112), respectively. In culture tests, the positive rate of the pathogen was 39.34% (48/122), much lower than that of DNA and RNA sequencing. In general, the positive rate of pathogen detection by sputum mNGS was significantly higher than that of sputum culture in the total and non-ICU groups (p < 0.001) but did not show a significant difference when compared to the result of sputum culture in the ICU group (p = 0.08). spp., , spp., and viruses from the mNGS results were excluded before comparing the overall performance of these two methods in pathogen detection. Specifically, among the 10 most common bacteria implied from the mNGS results, significant differences were observed in the number of cases of , , , , , , and between the ICU and non-ICU groups (p < 0.05).
CONCLUSIONS
This study demonstrated the superiority of mNGS over culture in detecting all kinds of pathogen species in sputum samples. These results indicate that mNGS may serve as a valuable tool to identify pathogens, especially for ICU patients who are more susceptible to mixed infections.
目的
评估宏基因组下一代测序（mNGS）和培养在疑似肺部感染的 ICU 和非 ICU 患者中病原体检测的诊断性能。
方法
在这项前瞻性研究中，连续 2 天采集疑似肺部感染患者的痰标本，进行 mNGS 或培养的 DNA 或 RNA 测序；共纳入 62 例 ICU 患者和 60 例非 ICU 患者。最终比较 mNGS 和培养鉴定的病原体种类、两种方法在病原体检测中的整体性能以及 ICU 和非 ICU 组中 mNGS 检测到的最常见病原体。
结果
在 DNA 和 RNA 测序中，病原体检测的阳性率分别达到 96.69%（117/121）和 96.43%（108/112）。培养试验中，病原体的阳性率为 39.34%（48/122），明显低于 DNA 和 RNA 测序。总体而言，mNGS 检测痰标本病原体的阳性率明显高于总人群和非 ICU 组的痰培养（p<0.001），但与 ICU 组的痰培养结果相比无显著差异（p=0.08）。在比较两种方法在病原体检测中的整体性能之前，将 mNGS 结果中的 spp.、 spp.、 spp. 和病毒排除在外。具体而言，在 mNGS 结果中暗示的 10 种最常见细菌中，ICU 和非 ICU 组之间的 、 、 、 、 、 和 病例数存在显著差异（p<0.05）。
结论
本研究表明 mNGS 在检测痰标本中各种病原体方面优于培养。这些结果表明 mNGS 可能是一种有价值的病原体鉴定工具，尤其适用于更易发生混合感染的 ICU 患者。
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