Department of Intensive Care Unit, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China.
Department of Clinical Laboratory, Huanghe Sanmenxia Hospital Affiliated to Henan University of Science and Technology, Sanmenxia, China.
Front Cell Infect Microbiol. 2023 Mar 16;13:1136588. doi: 10.3389/fcimb.2023.1136588. eCollection 2023.
Community-acquired pneumonia (CAP) is an extraordinarily heterogeneous illness, both in the range of responsible pathogens and the host response. Metagenomic next-generation sequencing (mNGS) is a promising technology for pathogen detection. However, the clinical application of mNGS for pathogen detection remains challenging.
A total of 205 patients with CAP admitted to the intensive care unit were recruited, and broncho alveolar lavage fluids (BALFs) from 83 patients, sputum samples from 33 cases, and blood from 89 cases were collected for pathogen detection by mNGS. At the same time, multiple samples of each patient were tested by culture. The diagnostic performance was compared between mNGS and culture for pathogen detection.
The positive rate of pathogen detection by mNGS in BALF and sputum samples was 89.2% and 97.0%, which was significantly higher ( < 0.001) than that (67.4%) of blood samples. The positive rate of mNGS was significantly higher than that of culture (81.0% vs. 56.1%, = 1.052e-07). A group of pathogens including , , and were only detected by mNGS. Based on mNGS results, was the most common pathogen (15/61, 24.59%) of non-severe patients with CAP, and was the most common pathogen (21/144, 14.58%) leading to severe pneumonia. was the most common pathogen (26.09%) in severe CAP patients with an immunocompromised status, which was all detected by mNGS only.
mNGS has higher overall sensitivity for pathogen detection than culture, BALF, and sputum mNGS are more sensitive than blood mNGS. mNGS is a necessary supplement of conventional microbiological tests for the pathogen detection of pulmonary infection.
社区获得性肺炎（CAP）在致病病原体和宿主反应方面均具有极高的异质性。宏基因组下一代测序（mNGS）是一种很有前途的病原体检测技术。然而，mNGS 用于病原体检测的临床应用仍然具有挑战性。
共招募了 205 例因 CAP 入住重症监护病房的患者，对 83 例患者的支气管肺泡灌洗液（BALF）、33 例患者的痰液样本和 89 例患者的血液样本进行了 mNGS 检测。同时，对每位患者的多种样本进行了培养检测。比较 mNGS 与培养法检测病原体的诊断性能。
BALF 和痰液样本中 mNGS 检测病原体的阳性率分别为 89.2%和 97.0%，明显高于（<0.001）血液样本的 67.4%。mNGS 的阳性率明显高于培养法（81.0%比 56.1%，=1.052e-07）。一组病原体如 、 、 仅通过 mNGS 检测到。根据 mNGS 结果，非重症 CAP 患者最常见的病原体是（15/61，24.59%），导致重症肺炎的最常见病原体是（21/144，14.58%）。免疫功能低下的重症 CAP 患者最常见的病原体是（26.09%），这些均仅通过 mNGS 检测到。
mNGS 检测病原体的总敏感性高于培养法，BALF 和痰液 mNGS 比血液 mNGS 更敏感。mNGS 是肺部感染病原体检测常规微生物学检测的必要补充。
