Clinical Value of Metagenomics Next-Generation Sequencing in Antibiotic Resistance of a Patient with Severe Refractory Pneumonia: A Case Report.

BACKGROUND

is an important infectious pathogen of lower respiratory tract infection in children and adolescents. Macrolide resistant (MRMP) has become increasingly prevalent, and identifying pathogen resistance genes is crucial for treatment.

CASE PRESENTATION

We report a patient with severe refractory pneumonia (MPP). The failure of initial clinical treatment prompted the re-analysis of metagenomic next-generation sequencing (mNGS) data for macrolide-resistant gene. Macrolide-resistance 23S ribosomal RNA gene was confirmed with read depth of 64 X for the A2063G mutation, which can decrease the affinity of macrolide with ribosome resulting in macrolide resistance. Furthermore, antimicrobial susceptibility testing demonstrated that was resistant to macrolide. PCR confirmatory test about resistance A2063G mutation, clinical treatment course and prognosis with altered treatment strategy, and antimicrobial susceptibility confirmed that the severe refractory MPP was due to macrolide resistant .

CONCLUSION

As a new molecular level detection, mNGS is an effective method for detecting resistance genes. Early recognition of macrolide resistance and suitable antibiotics strategy is of vital importance for the prognosis of severe refractory MPP.