State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Collaborative Innovation Center of Hematology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Cell Infect Microbiol. 2023 Sep 13;13:1251509. doi: 10.3389/fcimb.2023.1251509. eCollection 2023.
Immunosuppression predisposes allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients to infection. Prompt and accurate identification of pathogens is crucial to optimize treatment strategies. This multi-center retrospective study aimed to assess the ability of metagenomic next-generation sequencing (mNGS) to detect causative pathogens in febrile allo-HSCT recipients and examined its concordance with conventional microbiological tests (CMT).
We performed mNGS and CMT on samples obtained from 153 patients with suspected infection during allo-HSCT. Patients were grouped based on their neutropenic status at the time of sampling.
The mNGS test was more sensitive than CMT (81.1% vs. 53.6%, <0.001) for diagnosing clinically suspected infection, especially in the non-neutropenia cohort. mNGS could detect fungi and viruses better than bacteria, with a higher sensitivity than CMT. Immune events were diagnosed in 57.4% (35/61) of the febrile events with negative mNGS results, and 33.5% (48/143) with negative CMT results (=0.002). The treatment success rate of the targeted anti-infection strategy was significantly higher when based on mNGS than on empirical antibiotics (85% vs. 56.5%, =0.004).
The mNGS test is superior to CMT for identifying clinically relevant pathogens, and provides valuable information for anti-infection strategies in allo-HSCT recipients. Additionally, attention should be paid to immune events in patients with negative mNGS results.
免疫抑制使异基因造血干细胞移植（allo-HSCT）受者易感染。及时准确地识别病原体对于优化治疗策略至关重要。本多中心回顾性研究旨在评估宏基因组下一代测序（mNGS）在发热性 allo-HSCT 受者中检测病原体的能力，并研究其与传统微生物学检测（CMT）的一致性。
我们对 153 例疑似 allo-HSCT 感染患者的样本进行了 mNGS 和 CMT 检测。根据采样时的中性粒细胞减少状态将患者分组。
mNGS 试验比 CMT （81.1% vs. 53.6%，<0.001）更能诊断临床疑似感染，特别是在非中性粒细胞减少组。mNGS 比 CMT 能更好地检测真菌和病毒，其灵敏度也更高。在 mNGS 结果阴性的 57.4%（35/61）发热事件和 CMT 结果阴性的 33.5%（48/143）发热事件中诊断出免疫事件（=0.002）。基于 mNGS 的靶向抗感染策略的治疗成功率明显高于经验性抗生素（85% vs. 56.5%，=0.004）。
mNGS 试验比 CMT 更能识别临床相关病原体，为 allo-HSCT 受者的抗感染策略提供有价值的信息。此外，应注意 mNGS 结果阴性患者的免疫事件。
