Department of the Clinical Research Center, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China.
Department of Urology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, China.
Front Public Health. 2022 Aug 22;10:901549. doi: 10.3389/fpubh.2022.901549. eCollection 2022.
Rapid and accurate pathogen diagnosis is an urgent unmet clinical need for recurrent urinary tract infection (RUTI) in kidney transplant recipients (KTRs). Metagenomic next-generation sequencing (mNGS) may offer another strategy for diagnosing uropathogens but remains to be studied.
Nineteen KTRs with RUTI were collected in this study. The uropathogens were detected and compared by mNGS and urine culture, respectively. Modifications of the anti-infection strategy were also assessed.
Rich and diverse pathogens were revealed by mNGS. mNGS was significantly higher than culture in total positive rate (100.0% vs. 31.6%; < 0.01) and in identification rates for bacteria (89.5% vs. 31.6%; < 0.01), for viruses (57.9% vs. 0; < 0.01), and for fungi (42.1% vs. 0; < 0.01), respectively. mNGS identified a significantly higher proportion of mixed infections than culture (89.5% vs. 10.5%; < 0.01). The anti-infection therapies were adjusted in two (33.3%) and 12 (76.9%) cases guided by culture and mNGS, respectively.
mNGS has more remarkable etiological diagnostic performance compared with urine culture for KTRs with RUTI to guide anti-infection strategies and, in turn, protect the graft.
对于肾移植受者（KTR）复发性尿路感染（RUTI），快速准确的病原体诊断是一项迫切未满足的临床需求。宏基因组下一代测序（mNGS）可能为诊断尿路病原体提供另一种策略，但仍需研究。
本研究共收集了 19 例 RUTI 的 KTR。分别通过 mNGS 和尿培养检测和比较尿病原体。还评估了抗感染策略的改变。
mNGS 揭示了丰富多样的病原体。mNGS 的总阳性率（100.0%比 31.6%；<0.01）和细菌（89.5%比 31.6%；<0.01）、病毒（57.9%比 0；<0.01）和真菌（42.1%比 0；<0.01）的鉴定率均显著高于培养。mNGS 鉴定混合感染的比例显著高于培养（89.5%比 10.5%；<0.01）。根据培养和 mNGS 分别指导 2 例（33.3%）和 12 例（76.9%）调整抗感染治疗。
mNGS 与尿培养相比，对 RUTI 的 KTR 具有更显著的病因诊断性能，可指导抗感染策略，从而保护移植物。
