Department of Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
School of Biological Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
Front Cell Infect Microbiol. 2023 Jan 13;12:1094518. doi: 10.3389/fcimb.2022.1094518. eCollection 2022.
The metagenomics next-generation sequencing (mNGS) is a promising technique for pathogens diagnosis. However, whether the application of mNGS in critically ill patients with pneumonia could cause anti-infection treatment adjustment and thereby affect the prognosis of these patients has not been explored.
We retrospectively collected the clinical data of patients diagnosed with pulmonary infection in the ICU of the Affiliated Hospital of Qingdao University from January 2018 to January 2021. These patients with pneumonia were divided into mNGS group and no-mNGS group by whether being performed NGS or not. The clinical data, including demographics, illness history, APACHE II score, length of mechanical ventilation, length of stay in the hospital, length of stay in ICU and outcome, were collected. In addition, the data of pathogens and anti-infection treatment before and after NGS were also collected. Propensity score matching was performed to evaluate the mortality and deterioration rate between NGS group and non-NGS group.
A total of 641 patients diagnosed with pneumonia were screened, and 94 patients were excluded based on exclusion criteria. Finally, 547 patients were enrolled, including 160 patients being performed NGS. Among these 160 patients, 142 cases had NGS-positive results. In addition, new pathogens were detected in 132 specimens by NGS, which included 82 cases with virus, 18 cases with fungus, 17 cases with bacteria, 14 cases with mycoplasma, and 1 case with mycobacterium tuberculosis. Anti-infection treatments were adjusted in some patients who performed NGS, including 48 anti-bacterial treatments, 20 antifungal treatments and 20 antiviral treatments. There were no significant differences in the mortality and deterioration rate between NGS and non-NGS group, but it exhibited a trend that the mortality and deterioration rate of NGS group was lower than non-NGS group after the propensity score matching analysis (15.8% vs 24.3%, P=0.173; 25.6% vs 37.8%, P=0.093).
NGS could affect the anti-infection treatments and had a trend of reducing the mortality and deterioration rate of critically ill patients with pneumonia.
宏基因组下一代测序（mNGS）是一种很有前途的病原体诊断技术。然而，mNGS 在肺炎重症患者中的应用是否会导致抗感染治疗的调整，从而影响这些患者的预后，尚未得到探索。
我们回顾性收集了 2018 年 1 月至 2021 年 1 月期间在青岛大学附属医院 ICU 诊断为肺部感染的患者的临床资料。这些肺炎患者根据是否进行 NGS 检测分为 mNGS 组和非 mNGS 组。收集患者的临床数据，包括人口统计学、病史、急性生理与慢性健康评分（APACHE II）评分、机械通气时间、住院时间、住 ICU 时间和结局等。此外，还收集了 NGS 前后病原体和抗感染治疗的数据。采用倾向评分匹配法评估 mNGS 组和非 mNGS 组的死亡率和恶化率。
共筛选出 641 例肺炎患者，根据排除标准排除 94 例，最终纳入 547 例患者，其中 160 例进行了 NGS。在这 160 例患者中，有 142 例 NGS 结果阳性。此外，132 份标本通过 NGS 检测到新的病原体，包括病毒 82 例、真菌 18 例、细菌 17 例、支原体 14 例和结核分枝杆菌 1 例。一些进行 NGS 的患者调整了抗感染治疗，包括 48 例抗菌治疗、20 例抗真菌治疗和 20 例抗病毒治疗。在倾向评分匹配分析后，mNGS 组与非 mNGS 组的死亡率和恶化率无显著差异，但 mNGS 组的死亡率和恶化率有低于非 mNGS 组的趋势（15.8%比 24.3%，P=0.173；25.6%比 37.8%，P=0.093）。
NGS 可以影响抗感染治疗，并有降低肺炎重症患者死亡率和恶化率的趋势。
