Li Shixiao, Zhou Peng, Yang Lihong, Tang Tianbin, Qin Jiajia, Qian Jiao, Bo Shen, Yu Sufei
Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, People's Republic of China.
Department of Pharmacy, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China.
Infect Drug Resist. 2023 Aug 14;16:5263-5274. doi: 10.2147/IDR.S424185. eCollection 2023.
Severe pneumonia is a common infectious disease with high morbidity and mortality. Early etiological diagnosis is crucial for improving the prognosis. The aim of this study is to evaluate the clinical value of sampling time of mNGS in patients with severe pneumonia.
This retrospective study enrolled 105 patients with severe pneumonia. mNGS was performed on bronchoalveolar lavage fluid (BALF). Patients were divided into the sampling time ≤ 72h vs sampling time >72h groups and survivors vs non-survivors groups according to their sampling time and prognosis. Clinical characteristics, the adjustment of antibiotics and clinical prognostic value were evaluated.
Our study showed that, early sampling of mNGS can significantly shorten the mechanical ventilation time ( = 0.007) and hospitalization time ( = 0.004). In the non-survivors group, CURB-65, SOFA, and APACHE II scores were higher. Age (OR: 1.051, 95% CI: 1.004-1.100, = 0.034), chronic respiratory diseases (OR: 4.639, 95% CI: 1.260-17.082, = 0.021), immunosuppression (OR: 5.008, 95% CI: 1.617-15.510, = 0.005) and SOFA score on the day of mNGS sampling (OR: 1.492, 95% CI: 1.212-1.837, < 0.001) were independent risk factors of in-hospital mortality. The most common pathogens were and 4. The proportion of appropriate and targeted antibiotics adjusted was significantly higher than that in the sampling time > 72h group, and the proportion of antifungal and antiviral agents adjusted was lower. In the early sampling group, it was significantly decreased in the CRP, PCT level and NEU% at discharge.
This study demonstrated that early sampling of mNGS could shorten the time of mechanical ventilation and hospitalization of patients with severe pneumonia. Patients with higher SOFA score on the day of sampling had a poorer prognosis. It emphasizes that early sampling of mNGS has a positive value.
重症肺炎是一种常见的传染病，发病率和死亡率高。早期病因诊断对改善预后至关重要。本研究旨在评估重症肺炎患者mNGS采样时间的临床价值。
本回顾性研究纳入105例重症肺炎患者。对支气管肺泡灌洗液（BALF）进行mNGS检测。根据采样时间和预后将患者分为采样时间≤72小时组与采样时间>72小时组以及存活组与非存活组。评估临床特征、抗生素调整情况及临床预后价值。
我们的研究表明，mNGS早期采样可显著缩短机械通气时间（P = 0.007）和住院时间（P = 0.004）。在非存活组中，CURB - 65、SOFA和APACHE II评分更高。年龄（OR：1.051，95%CI：1.004 - 1.100，P = 0.034）、慢性呼吸系统疾病（OR：4.639，95%CI：1.260 - 17.082，P = 0.021）、免疫抑制（OR：5.008，95%CI：1.617 - 15.510，P = 0.005）以及mNGS采样当天的SOFA评分（OR：1.492，95%CI：1.212 - 1.837，P < 0.001）是院内死亡的独立危险因素。最常见的病原体是[具体病原体1]和[具体病原体2]。适当且有针对性调整抗生素的比例显著高于采样时间>72小时组，抗真菌和抗病毒药物调整的比例较低。在早期采样组中，出院时CRP、PCT水平和NEU%显著降低。
本研究表明，mNGS早期采样可缩短重症肺炎患者的机械通气时间和住院时间。采样当天SOFA评分较高的患者预后较差。强调mNGS早期采样具有积极价值。
