Intensive Care Unit, Annecy-Genevois Hospital, Site d'Annecy, 1 Avenue de L'hôpital, 74370, Metz Tessy, France.
Genomic Research Laboratory, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Respir Res. 2023 Nov 15;24(1):285. doi: 10.1186/s12931-023-02597-x.
Hospital-acquired and ventilator-associated-pneumonia (HAP/VAP) are one of the most prevalent health-care associated infections in the intensive care unit (ICU). Culture-independent methods were therefore developed to provide faster route to diagnosis and treatment. Among these, metagenomic next-generation sequencing (mNGS) has shown considerable promise.
This proof-of-concept study describes the technical feasibility and evaluates the clinical validity of the mNGS for the detection and characterization of the etiologic agents causing hospital-acquired and ventilator-associated pneumonia. We performed a prospective study of all patients with HAP/VAP hospitalized in our intensive care unit for whom a bronchoalveolar lavage (BAL) was performed between July 2017 and November 2018. We compared BAL fluid culture and mNGS results of these patients.
A total of 32 BAL fluids were fully analyzed. Of these, 22 (69%) were positive by culture and all pathogens identified were also reported by mNGS. Among the culture-positive BAL samples, additional bacterial species were revealed by mNGS for 12 patients, raising the issue of their pathogenic role (colonization versus coinfection). Among BALF with culture-negative test, 5 were positive in mNGS test.
This study revealed concordant results for pneumonia panel pathogens between mNGS and culture-positive tests and identified additional pathogens potentially implicated in pneumonia without etiologic diagnosis by culture. mNGS has emerged as a promising methodology for infectious disease diagnoses to support conventional methods. Prospective studies with real-time mNGS are warranted to examine the impact on antimicrobial decision-making and clinical outcome.
医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP）是重症监护病房（ICU）中最常见的医院获得性感染之一。因此，开发了非培养依赖性方法以提供更快的诊断和治疗途径。其中，宏基因组下一代测序（mNGS）显示出相当大的潜力。
本概念验证研究描述了 mNGS 检测和鉴定引起医院获得性肺炎和呼吸机相关性肺炎的病原体的技术可行性，并评估了其临床有效性。我们对 2017 年 7 月至 2018 年 11 月期间在我们的重症监护病房住院的所有 HAP/VAP 患者进行了前瞻性研究，对这些患者进行了支气管肺泡灌洗（BAL）。我们比较了这些患者的 BAL 液培养和 mNGS 结果。
共对 32 份 BAL 液进行了全面分析。其中，22 份（69%）通过培养呈阳性，mNGS 也报告了所有鉴定的病原体。在培养阳性的 BAL 样本中，mNGS 为 12 名患者揭示了其他细菌种类，这引发了它们的致病作用（定植与共感染）问题。在培养阴性的 BALF 中，有 5 份 mNGS 检测呈阳性。
本研究显示 mNGS 与培养阳性试验之间肺炎Panel 病原体的结果一致，并鉴定了培养未能确定病因的肺炎中潜在相关的其他病原体。mNGS 已成为一种有前途的传染病诊断方法，可支持常规方法。需要进行前瞻性研究，实时 mNGS，以检查其对抗菌药物决策和临床结果的影响。
