脓毒症重症患者宏基因组下一代测序的临床特征及测序时机的影响
Clinical Characteristics and the Effect of Timing for Metagenomic Next-Generation Sequencing in Critically Ill Patients with Sepsis.
作者信息
He Dehua, Liu Ming, Chen Qimin, Liu Ying, Tang Yan, Shen Feng, Wang Difen, Liu Xu
机构信息
Department of Critical Care Medicine, the Affiliated Hospital of Guizhou Medical University, Guiyang, People's Republic of China.
出版信息
Infect Drug Resist. 2022 Dec 14;15:7377-7387. doi: 10.2147/IDR.S390256. eCollection 2022.
BACKGROUND
Metagenomic next-generation sequencing (mNGS) has a good performance for the identification of pathogens in infectious diseases, but few studies on the clinical characteristics of mNGS and the effect of timing for mNGS in critically ill patients with sepsis.
METHODS
We retrospectively included all patients diagnosed with sepsis after admission to the intensive care unit (ICU) of a university-affiliated hospital between Aug 1, 2019 and Apr 1, 2021. During the study period, pathogens for all enrolled subjects were obtained by mNGS. We analyzed the composition and positive rate of different samples type for mNGS. And then we used the univariable and multivariable logistic regression to explore the risk factors associated with all-cause mortality at 28 days.
RESULTS
A total of 87 patients were included and 87 samples were analyzed among these patients. The most common sample for mNGS was bronchoalveolar lavage fluid (BALF), about 84% (73/87). The positive rate of pathogens identification by mNGS was higher than conventional culture (92% vs 36%, p < 0.001). In addition to the pathogens detected by conventional culture, mNGS can detect more viruses and fungi. Based on the mNGS report, clinicians made adjustments to the antibiotic regimen for 72% patients. The multivariate binary logistic regression analysis suggested that age (OR, 1.036; 95% CI, 1.005-1.067; p = 0.021) and the sequential organ failure assessment (SOFA) score on the day of mNGS sampling were independent risk factors of death at 28 days (OR, 1.204; 95% CI, 1.038-1.397; p = 0.014).
CONCLUSION
In critically ill patients with sepsis, the most common sample type for mNGS was BALF, and the positive rate of mNGS is higher than conventional cultures, especially in viruses and fungi. Meanwhile, mNGS can guide clinicians in adjusting antibiotic regimens. Age and the SOFA score on the day of mNGS sampling were independent risk factors for death.
背景
宏基因组下一代测序（mNGS）在感染性疾病病原体鉴定方面表现良好，但针对重症脓毒症患者，关于mNGS临床特征及mNGS检测时机影响的研究较少。
方法
我们回顾性纳入了2019年8月1日至2021年4月1日期间在某大学附属医院重症监护病房（ICU）入院后被诊断为脓毒症的所有患者。在研究期间，通过mNGS获取所有纳入研究对象的病原体。我们分析了mNGS不同样本类型的组成及阳性率。然后采用单变量和多变量逻辑回归分析来探究与28天全因死亡率相关的危险因素。
结果
共纳入87例患者，并对这些患者的87份样本进行了分析。mNGS最常用的样本是支气管肺泡灌洗液（BALF），约占84%（73/87）。mNGS鉴定病原体的阳性率高于传统培养（92%对36%，p<0.001）。除了传统培养检测到的病原体外，mNGS还能检测到更多病毒和真菌。基于mNGS报告，72%的患者临床医生调整了抗生素治疗方案。多变量二元逻辑回归分析表明，年龄（OR，1.036；95%CI，1.005 - 1.067；p = 0.021）和mNGS采样当天的序贯器官衰竭评估（SOFA）评分是28天死亡的独立危险因素（OR，1.204；95%CI，1.038 - 1.397；p = 0.014）。
结论
在重症脓毒症患者中，mNGS最常用样本类型是BALF，mNGS阳性率高于传统培养，尤其是在病毒和真菌方面。同时，mNGS可指导临床医生调整抗生素治疗方案。年龄和mNGS采样当天的SOFA评分是死亡的独立危险因素。
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