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宏基因组二代测序在疑似脓毒症患者血浆中的临床诊断应用

Clinical Diagnosis Application of Metagenomic Next-Generation Sequencing of Plasma in Suspected Sepsis.

作者信息

Wang Lisha, Li Shixiao, Qin Jiajia, Tang Tianbin, Hong Jiawen, Tung Tao-Hsin, Xu Chunyan, Yu Sufei, Qian Jiao

机构信息

Department of Laboratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, People's Republic of China.

Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, People's Republic of China.

出版信息

Infect Drug Resist. 2023 Feb 14;16:891-901. doi: 10.2147/IDR.S395700. eCollection 2023.

Abstract

PURPOSE

We analyzed the clinical concordance of mNGS test results from blood samples and improved the clinical efficiency of mNGS in the diagnosis of suspected sepsis pathogens.

PATIENTS AND METHODS

In this study, 99 samples of suspected blood flow infection were included for plasma mNGS, and the correlation between mNGS results and blood culture results, serum inflammatory indices, clinical symptoms and antibiotic treatment was analyzed, as well as the comparison with the detection rate of BALF pathogens, as well as the classification of different pathogens in the mNGS results were analyzed.

RESULTS

The mNGS pathogen detection rate was higher than that of traditional blood culture (83.02% vs 35.82%). The rate of the mNGS results being consistent with the clinical diagnosis was also higher than that of traditional blood culture (58.49% vs 20.75%). This study shows that bacteria and fungi are the main pathogens in sepsis, and viral sepsis is very rare. In this study, 32% of sepsis patients were secondary to pneumonia. Compared with the pathogen detection rate using alveolar lavage fluid, the detection rate from plasma mNGS was 62.5%. Samples were also easy to sample, noninvasive, and more convenient for clinical application.

CONCLUSION

This study shows that compared with blood culture, the detection rate of mNGS pathogen that meets the diagnosis of sepsis is higher. We need a combination of multiple indicators to monitor the early diagnosis and treatment of sepsis.

摘要

目的

我们分析了血液样本中宏基因组二代测序(mNGS)检测结果的临床一致性,并提高了mNGS在疑似脓毒症病原体诊断中的临床效率。

患者和方法

本研究纳入99例疑似血流感染样本进行血浆mNGS检测,分析mNGS结果与血培养结果、血清炎症指标、临床症状及抗生素治疗之间的相关性,以及与支气管肺泡灌洗(BALF)病原体检出率的比较,同时分析mNGS结果中不同病原体的分类情况。

结果

mNGS病原体检出率高于传统血培养(83.02%对35.82%)。mNGS结果与临床诊断一致的比例也高于传统血培养(58.49%对20.75%)。本研究表明,细菌和真菌是脓毒症的主要病原体,病毒脓毒症非常罕见。本研究中,32%的脓毒症患者继发于肺炎。与使用肺泡灌洗液的病原体检出率相比,血浆mNGS的检出率为62.5%。样本采集也很容易,是非侵入性的,更便于临床应用。

结论

本研究表明,与血培养相比,符合脓毒症诊断的mNGS病原体检出率更高。我们需要综合多种指标来监测脓毒症的早期诊断和治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b17c/9938705/4fca53349019/IDR-16-891-g0001.jpg

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